title: The effect of chart speed on fetal monitor interpretation.
abstract: OBJECTIVE
  Electronic fetal heart monitor chart speeds vary between countries, and it is unclear whether differing chart speeds affect physician tracing interpretation.
  
  
  METHODS
  Twenty-minute segments of 19 tracings were displayed on both 1 and 3 cm/min strips and interpreted by 14 physicians at the particular speed they were accustomed to reading. Interpretations of tracing characteristics were compared between groups using free margin kappa, a measure of interobserver agreement.
  
  
  RESULTS
  Compared to 3 cm/min tracings, 1 cm/min tracings were significantly more often identified as having absent than minimal variability, and minimal than moderate variability. Accelerations were significantly more often identified in 1 versus 3 cm/min strips. There were no significant differences between groups with respect to baseline fetal heart rate, prolonged or repetitive decelerations, or American College of Obstetricians and Gynecologists tracing category. Neither chart speed had substantial interobserver agreement in tracing variables; however, agreement was consistently higher in 3 versus 1 cm/min tracings (all p < 0.05).
  
  
  CONCLUSIONS
  Tracing interpretation is significantly affected by fetal monitor chart speed with regards to variability, acceleration and deceleration. Further studies are required to determine if differences in chart speed interpretation affect clinical management.
authors.affiliation: a Department of Obstetrics and Gynecology, Faculty of Medicine , Ziv Medical Center Affiliated with the Bar-Ilan University , Galilee , Israel .
authors.forename: David
authors.initials: D
authors.lastname: Peleg
authors.affiliation: a Department of Obstetrics and Gynecology, Faculty of Medicine , Ziv Medical Center Affiliated with the Bar-Ilan University , Galilee , Israel .
authors.forename: Reut
authors.initials: R
authors.lastname: Ram
authors.affiliation: b Division of Maternal-Fetal Medicine , Eastern Virginia Medical School , Norfolk , VA , USA , and.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Warsof
authors.affiliation: a Department of Obstetrics and Gynecology, Faculty of Medicine , Ziv Medical Center Affiliated with the Bar-Ilan University , Galilee , Israel .
authors.forename: Maya Frank
authors.initials: MF
authors.lastname: Wolf
authors.affiliation: b Division of Maternal-Fetal Medicine , Eastern Virginia Medical School , Norfolk , VA , USA , and.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Larion
authors.affiliation: c Graduate Program in Public Health, Eastern Virginia Medical School , Norfolk , VA , USA.
authors.forename: Hind A
authors.initials: HA
authors.lastname: Beydoun
authors.affiliation: b Division of Maternal-Fetal Medicine , Eastern Virginia Medical School , Norfolk , VA , USA , and.
authors.forename: Sarine
authors.initials: S
authors.lastname: Trochakerian
authors.affiliation: a Department of Obstetrics and Gynecology, Faculty of Medicine , Ziv Medical Center Affiliated with the Bar-Ilan University , Galilee , Israel .
authors.forename: Inbar
authors.initials: I
authors.lastname: Ben Shachar
mesh_terms: D015148:Cardiotocography / Q000295:instrumentation*; D005260:Female; D006340:Heart Rate, Fetal; D006801:Humans; D011247:Pregnancy
keywords: Fetal assessment; fetal heart monitor chart speed; fetal heart rate; intrapartum fetal assessment