Can the reproducibility of fetal heart rate baseline estimation be improved?
OBJECTIVE
To evaluate the reproducibility of fetal heart rate (FHR) baseline estimation according to an objective and detailed definition presented in this article, by comparison with the FIGO guidelines' definition.


METHODS
Three hundred consecutively acquired FHR tracings, 150 from antepartum high-risk pregnancies and 150 from unselected intrapartum cases, were presented to nine experienced clinicians included in three different groups, for an estimation of the FHR baseline. The first group consisted of clinicians using the proposed definition, without previous training in its use. The second group consisted of clinicians using the proposed definition, where a previous training session was promoted. The third group consisted of clinicians using the FIGO guidelines' definition. Agreement in baseline estimation was evaluated using the kappa statistic, the proportions of agreement and the intra-class correlation coefficient.


RESULTS
Using the baseline definition proposed in this article, agreement was significantly higher in the group with prior training in its use. This group also showed a trend towards a higher agreement than the one using the FIGO guidelines.


CONCLUSIONS
The FHR baseline definition proposed in this article provides an extremely reproducible estimation when associated with prior training in its use.
Ayres-de-Campos
Diogo
D
Department of Obstetrics and Gynaecology, Faculdade de Medicina do Porto, 4200 Porto, Portugal. sisporto@med.up.pt
Bernardes
João
J
Marsal
Karel
K
Nickelsen
Carsten
C
Makarainen
Leo
L
Banfield
Philip
P
Xavier
Pedro
P
Campos
Isabel
I
D000328:Adult; D002983:Clinical Competence; D004562:Electrocardiography; D005260:Female; D005323:Fetal Monitoring / Q000592:standards* / Q000639:trends; D005865:Gestational Age; D019983:Guideline Adherence; D006340:Heart Rate, Fetal; D006801:Humans; D007743:Labor, Obstetric; D015588:Observer Variation; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D015203:Reproducibility of Results; D012494:Sampling Studies