title: Agreement on intrapartum cardiotocogram recordings between expert obstetricians.
abstract: OBJECTIVE
  To evaluate obstetricians' inter- and intra-observer agreement on intrapartum cardiotocogram (CTG) recordings and to examine obstetricians' evaluations with respect to umbilical artery pH and base deficit.
  
  
  METHODS
  Nine experienced obstetricians annotated 634 intrapartum CTG recordings. The evaluation of each recording was divided into four steps: evaluation of two 30-minute windows in the first stage of labour, evaluation of one window in the second stage of labour and labour outcome prediction. The complete set of evaluations used for this experiment is available online. The inter- and intra-observer agreement was evaluated using proportion of agreement and kappa coefficient. Clinicians' sensitivity and specificity was computed with respect to umbilical artery pH, base deficit and to Apgar score at the fifth minute.
  
  
  RESULTS
  The overall proportion of agreement between clinicians reached 48% with 95% confidence intervals (CI) (CI: 47-50). Regarding the different classes, proportion of agreement ranged from 57% (CI: 54-60) for normal to 41% (CI: 36-46) for pathological class. The sensitivity of clinicians' majority vote to objective outcome was 39% (CI: 16-63) for the umbilical artery base deficit and 27% (CI: 16-42) for pH. The specificity was 89% (CI: 86-92) for both types of objective outcome.
  
  
  CONCLUSIONS
  The reported inter-/intra-observer variability is large and this holds irrespective of clinicians' experience or work place. The results support the need of modernized guidelines for CTG evaluation and/or objectivization and repeatability by introduction of a computerized approach that could standardize the process of CTG evaluation within the delivery ward.
authors.affiliation: Department of Gynecology and Obstetrics, Masaryk University Hospital, Brno, Czech Republic.
authors.forename: Lukáš
authors.initials: L
authors.lastname: Hruban
authors.affiliation: Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic.|Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University in Prague, Prague, Czech Republic.
authors.forename: Jiří
authors.initials: J
authors.lastname: Spilka
authors.affiliation: Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic.|Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University in Prague, Prague, Czech Republic.
authors.forename: Václav
authors.initials: V
authors.lastname: Chudáček
authors.affiliation: Department of Gynecology and Obstetrics, Masaryk University Hospital, Brno, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Janků
authors.affiliation: Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic.
authors.forename: Michal
authors.initials: M
authors.lastname: Huptych
authors.affiliation: Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Burša
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital in Plzeň, Plzeň, Czech Republic.
authors.forename: Adam
authors.initials: A
authors.lastname: Hudec
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital in Hradec Králové, Hradec Králové, Czech Republic.
authors.forename: Marian
authors.initials: M
authors.lastname: Kacerovský
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital in Prague, Prague, Czech Republic.
authors.forename: Michal
authors.initials: M
authors.lastname: Koucký
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital in Olomouc, Olomouc, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Procházka
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital in Plzeň, Plzeň, Czech Republic.
authors.forename: Vladimír
authors.initials: V
authors.lastname: Korečko
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Ostrava, Ostrava, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Seget'a
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Ostrava, Ostrava, Czech Republic.|Department of Surgical Studies, Ostrava University, Ostrava, Czech Republic.
authors.forename: Ondřej
authors.initials: O
authors.lastname: Šimetka
authors.affiliation: Department for Mother and Child Care, Prague Podolí, Prague, Czech Republic.
authors.forename: Alena
authors.initials: A
authors.lastname: Měchurová
authors.affiliation: Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic.
authors.forename: Lenka
authors.initials: L
authors.lastname: Lhotská
mesh_terms: D015148:Cardiotocography / Q000706:statistics & numerical data*; D002983:Clinical Competence; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015588:Observer Variation; D009774:Obstetrics / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012984:Software
keywords: cardiotocography; fetal heart rate; inter-observer variability; intra-observer variability