Developing a tool to appraise fetal monitoring guidelines for women at low obstetric risk.
OBJECTIVE
The aim of this paper is to report the development and use of a tool to appraise guidelines for fetal heart rate monitoring and discuss the findings generated in the appraisal process.


BACKGROUND
Expert guidance on the appropriate method of monitoring the fetal heart in labour has been available for some time. However, practices not based on evidence were continuing routinely in the United Kingdom.


METHODS
We produced an 18-item tool for the appraisal of guidelines. Heads of Midwifery Services were asked to send the guideline currently in use. Twenty-four out of 28 responded, and sent 32 guidelines. Pairs of multidisciplinary reviewers appraised each guideline.


RESULTS
A prevalidated generic appraisal instrument was not found to be appropriate for intrapartum fetal monitoring guidelines. When using our own specifically-developed appraisal tool for assessing the quality of fetal monitoring guidelines, only 11 reviewer pairs showed 'good' or 'moderate' agreement in their scores.


CONCLUSIONS
Generically-validated guidelines may not be sufficiently discriminatory for specialized areas of practice such as intrapartum fetal monitoring.
Hindley
Carol
C
School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK. carol.hindley@man.ac.uk
Hinsliff
Sophie W
SW
Thomson
Ann M
AM
D019317:Evidence-Based Medicine; D005260:Female; D005323:Fetal Monitoring / Q000592:standards*; D006340:Heart Rate, Fetal / Q000502:physiology*; D006801:Humans; D008880:Midwifery; D015588:Observer Variation; D010348:Patient Care Team; D017410:Practice Guidelines as Topic / Q000592:standards*; D011247:Pregnancy; D018570:Risk Assessment; D011795:Surveys and Questionnaires