Interobserver agreement in intrapartum estimation of fetal head station.
OBJECTIVE
To determine interobserver agreement in estimation of fetal head station during labor, and the determinants of agreement.


METHODS
A prospective study of fetal head station in 508 women in term labor. Vaginal examination of station was performed by a researcher at the same time as clinicians performed routine intrapartum assessments of the participants. Station 0 was considered to represent engagement.


RESULTS
Station could be estimated by both the researcher and clinicians in 446 women (88%). The kappa statistic for agreement was 0.23 (95% confidence interval, 0.17-0.29). There was agreement in 166 cases (37%) and disagreement by 1 cm in 208 (47%) cases. Agreement was best (50%) when the researcher assessed the head at station minus 1. Multiple regression analysis showed that agreement was not influenced by level of experience of the attending clinicians, nor by obstetric factors.


CONCLUSIONS
Estimation of station as a method of determining the level of the fetal head in labor appears imprecise and poorly reproducible.
Buchmann
Eckhart
E
Department of Obstetrics and Gynecology, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa. buchmannej@medicine.wits.ac.za
Libhaber
Elena
E
D000328:Adult; D002983:Clinical Competence; D005260:Female; D005323:Fetal Monitoring / Q000379:methods*; D006801:Humans; D007746:Labor Presentation; D007743:Labor, Obstetric / Q000502:physiology*; D015588:Observer Variation; D010173:Palpation / Q000379:methods*; D011247:Pregnancy; D011446:Prospective Studies; D012044:Regression Analysis; D015203:Reproducibility of Results