Evaluation of interobserver agreement of cardiotocograms.
OBJECTIVE
To evaluate interobserver agreement in visual analysis of each cardiotocographic event.


METHODS
Three experts independently divided 16 antepartum and 17 intrapartum cardiotocograms into baseline segments, accelerations and decelerations, according to the FIGO guidelines. Baseline segments were further classified as having normal, reduced or increased variability and decelerations as early, late and variable. Uterine activity was divided into tonus and contractions. Agreement was assessed by the proportions of agreement (pa) with 95% confidence intervals.


RESULTS
Reproducibility in assessment of baseline segments with normal variability, accelerations and uterine activity was acceptable (pa = 0.56-0.71) whereas that of other segments was not (pa = 0.14-0.45).


CONCLUSIONS
Analysis of most cardiotocographic events is poorly reproducible, even when experts use the FIGO guidelines. This may be explained by some still ambiguous guidelines, by eyeball limitations in evaluation of subtle events, and by the incapacity of busy clinicians to assess complex and multiple cardiotocographic events in a systematic and disciplined fashion.
Bernardes
J
J
Departamento de Ginecologia e Obstetrícia, Hospital de S. João, Faculdade de Medicina do Porto, Oporto, Portugal.
Costa-Pereira
A
A
Ayres-de-Campos
D
D
van Geijn
H P
HP
Pereira-Leite
L
L
D015148:Cardiotocography / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D005069:Evaluation Studies as Topic; D005260:Female; D006340:Heart Rate, Fetal / Q000502:physiology*; D006801:Humans; D015588:Observer Variation; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D015203:Reproducibility of Results; D013223:Statistics as Topic; D014590:Uterine Contraction / Q000502:physiology*