title: Guideline choice for CTG analysis influences first caesarean decision.
abstract: OBJECTIVE
  To compare intrapartum cardiotocography (CTG) analysis in case of first caesarean section (CS) for non-reassuring CTG according to international guidelines.
  
  
  METHODS
  Four ObGyns retrospectively analysed first CS for non-reassuring CTG during labour blind to neonatal outcome. CTG were analysed according to French National College of Obstetricians and Gynaecologists (CNGOF) and to the FIGO guidelines. First, CTG analysis was done without obstetrical context, then secondly, it was given. ObGyns stated if CS was justified or not. Inter-operator ObGyn agreement was analysed.
  
  
  RESULTS
  Among 587 CS, 100 women met the inclusion criteria with a first CS for non-reassuring CTG. The overall inter observer agreement was low but fair. ObGyns were significantly more concordant using the FIGO than the CNGOF guidelines (kappa coefficient = 0.331 [0.27-0.39] versus 0.209 [0.16-0.26] p < 0.001). Without obstetrical context 70% of CS were considered as unjustified. This rate decreased to 16% with the knowledge of the obstetrical context and the use of a classification (p < 0.001). Two-third of the unjustified CS were carried out during night hours (p = 0.026).
  
  
  CONCLUSIONS
  The FIGO guidelines are more reproducible than CNGOF guidelines. The overall inter-observer agreement was low but fair. The guideline choice could have an impact on first CS decision.
authors.affiliation: a Department of Gynaecology and Obstetrics , GYNEPOLE, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, AMU , Marseille , France.
authors.forename: Nadege
authors.initials: N
authors.lastname: Vejux
authors.affiliation: a Department of Gynaecology and Obstetrics , GYNEPOLE, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, AMU , Marseille , France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Ledu
authors.affiliation: a Department of Gynaecology and Obstetrics , GYNEPOLE, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, AMU , Marseille , France.|b Department of Public Health , Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, AMU , Marseille , France , and.
authors.forename: Claude
authors.initials: C
authors.lastname: D'ercole
authors.affiliation: a Department of Gynaecology and Obstetrics , GYNEPOLE, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, AMU , Marseille , France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Piechon
authors.affiliation: b Department of Public Health , Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, AMU , Marseille , France , and.
authors.forename: Anderson
authors.initials: A
authors.lastname: Loundou
authors.affiliation: a Department of Gynaecology and Obstetrics , GYNEPOLE, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, AMU , Marseille , France.|c Faculté de Médecine de Marseille , UMR CNRS-IRD 6236, Université de la Méditerranée , Marseille , France.
authors.forename: Florence
authors.initials: F
authors.lastname: Bretelle
mesh_terms: D000328:Adult; D015148:Cardiotocography; D002585:Cesarean Section / Q000706:statistics & numerical data; D000066491:Clinical Decision-Making / Q000379:methods*; D003657:Decision Making; D005260:Female; D005323:Fetal Monitoring / Q000379:methods; D005602:France; D005865:Gestational Age; D006340:Heart Rate, Fetal; D006801:Humans; D006863:Hydrogen-Ion Concentration; D009774:Obstetrics / Q000379:methods*; D010092:Oximetry; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D015203:Reproducibility of Results; D012189:Retrospective Studies
keywords: CTG; Labour; caesarean section; cardiotocography