title: Interobserver agreement in the assessment of intrapartum automated fetal electrocardiography in singleton pregnancies.
abstract: OBJECTIVE
  To study interobserver agreement in the assessment of intrapartum automated fetal electrocardiogram ST interval analysis (STAN).
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Labor ward in tertiary level university hospital. Sample. Two hundred (140 reassuring and 60 non-reassuring) STAN recordings on non-selected women with singleton, vertex, term pregnancies were selected from our archive. Samples of 60-min were analysed from the end of each recording, excluding the last 30 min before delivery.
  
  
  METHODS
  Three consultants, who had undergone STAN training and had clinical experience in using STAN, reviewed the recordings using cardiotocography (CTG) and ST information with no clinical data. The reviewers were asked to follow STAN guidelines and 1 to classify the CTG as normal, intermediary, abnormal, or preterminal, and 2 to make a clinical decision on labor management.
  
  
  METHODS
  Interobserver agreement evaluated by weighted kappa (kappa(w)) values and the proportion of agreement.
  
  
  RESULTS
  In CTG classification, the interobserver agreement between three observers was moderate (kappa(w), 0.47-0.48). The proportion of agreement was 56-59%. In clinical decision-making, kappa(w) values varied from 0.47 to 0.60, and the proportion of agreement was 80-86%.
  
  
  CONCLUSIONS
  In non-selected term pregnancies, the interobserver agreement among experienced obstetricians in the classification of CTG and clinical decision-making according to STAN guidelines is moderate at best.
authors.affiliation: Department of Obstetrics and Gynaecology, Oulu University Hospital, Oulu, Finland. kati.ojala@oulu.fi
authors.forename: Kati
authors.initials: K
authors.lastname: Ojala
authors.forename: Kaarin
authors.initials: K
authors.lastname: Mäkikallio
authors.forename: Mervi
authors.initials: M
authors.lastname: Haapsamo
authors.forename: Hilkka
authors.initials: H
authors.lastname: Ijäs
authors.forename: Aydin
authors.initials: A
authors.lastname: Tekay
mesh_terms: D015148:Cardiotocography / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005333:Fetus; D006340:Heart Rate, Fetal / Q000502:physiology*; D006801:Humans; D015588:Observer Variation; D018743:Perinatal Care / Q000379:methods; D011247:Pregnancy