title: Interobserver and intraobserver reliability of the NICHD 3-Tier Fetal Heart Rate Interpretation System.
abstract: OBJECTIVE
  Our purpose was to test the reliability of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) 3-Tier Fetal Heart Rate (FHR) classification system.
  
  
  METHODS
  Individual 15- to 20-minute FHR segments (n = 154) were independently reviewed without clinical data by 3 maternal-fetal medicine examiners and classified by NICHD category (I, II, III).
  
  
  RESULTS
  Interobserver reliability was moderate (kappa 0.45) and varied by NICHD category (category I moderate [kappa 0.48], category II moderate [kappa 0.44], and category III poor [kappa 0.0]). The intraobserver agreement ranged from substantial to perfect (kappa 0.74-1.0).
  
  
  CONCLUSIONS
  Interobserver agreement of 3-Tier FHR classification System was moderate for NICHD categories I and II. Agreement for category III tracings was poor mainly due to lack of agreement regarding absent vs minimal variability.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Sean C
authors.initials: SC
authors.lastname: Blackwell
authors.forename: William A
authors.initials: WA
authors.lastname: Grobman
authors.forename: Leah
authors.initials: L
authors.lastname: Antoniewicz
authors.forename: Maria
authors.initials: M
authors.lastname: Hutchinson
authors.forename: Cynthia
authors.initials: C
authors.lastname: Gyamfi Bannerman
mesh_terms: D015148:Cardiotocography / Q000706:statistics & numerical data*; D006340:Heart Rate, Fetal; D006801:Humans; D015588:Observer Variation; D015203:Reproducibility of Results