Accuracy of fetal heart-rate variability interpretation by obstetricians using the criteria of the National Institute of Child Health and Human Development compared with computer-aided interpretation.
OBJECTIVE
To evaluate the accuracy of fetal heart rate variability interpretation by obstetricians using the criteria of the National Institute of Child Health and Human Development (NICHD), compared with computer-aided analysis as a gold standard.


METHODS
One hundred and fourteen panels of fetal heart-rate tracings derived from electrocardiogram via scalp electrodes obtained from women with high-risk pregnancies during the intrapartum period. The tracings were interpreted using computer analysis and recorded as a gold standard. The same tracings were distributed to six observers: three residents in the third year of training and three faculty members. All observers blindly interpreted the fetal heart-rate variability without the knowledge of the computer analysis. The main outcome measures were: (i) the accuracy of fetal heart-rate variability interpretation by obstetricians using the NICHD criteria compared with computer-aided analysis was presented as a percentage value; and (ii) the agreement of fetal heart-rate variability interpretation between the obstetricians and the computer analysis using the NICHD criteria was presented as a kappa-value.


RESULTS
When using the computer analysis as a gold standard, the accuracy of fetal heart-rate variability interpretation in the residents group was 81.58%, 86.84% and 82.46%, respectively, with a mean of 83.62%, whereas the accuracy of the faculty members was 79.82%, 67.54% and 79.82%, respectively, with a mean of 75.73%. kappa-values, representing the agreement of interpretation, were 0.70, 0.78 and 0.72, with a mean of 0.73 +/- 0.04 among the residents, and 0.67, 0.50 and 0.68, with a mean of 0.62 +/- 0.10 among the faculty members. Agreements in the two groups were not significantly different (Student's t-test, P=0.14).


CONCLUSIONS
Using the NICHD criteria, the accuracy and agreement of fetal heart-rate variability interpretation in the third-year residents and faculty members are substantial. There was no difference between the groups with regard to the agreement of fetal heart-rate variability interpretation.
Tongsong
Theera
T
Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. ttongson@mail.med.cmu.ac.th
Iamthongin
Arunsri
A
Wanapirak
Chanane
C
Piyamongkol
Wirawit
W
Sirichotiyakul
Supatra
S
Boonyanurak
Pongrak
P
Tatiyapornkul
Teerapong
T
Neelasri
Chanthawat
C
D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000196:embryology; D002983:Clinical Competence / Q000706:statistics & numerical data*; D004562:Electrocardiography / Q000592:standards; D005260:Female; D005323:Fetal Monitoring / Q000592:standards*; D006801:Humans; D007743:Labor, Obstetric; D008503:Medical Staff; D009316:National Institutes of Health (U.S.); D015588:Observer Variation; D009774:Obstetrics / Q000193:education / Q000592:standards*; D011237:Predictive Value of Tests; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D012815:Signal Processing, Computer-Assisted; D013785:Thailand; D014481:United States