[Inter-observer variability of decision concerning the route of delivery in case of one previous cesarean section and abnormal pelvic measures].
OBJECTIVE
To study inter-observer variability of decision concerning the route of delivery using pelvimetry in case of one previous cesarean section and abnormal pelvic measures.


METHODS
Observational study conducted in 2014 in 4 university maternity units among 36 obstetricians. Two groups of obstetricians - as they practiced in a center where pelvimetry was routinely performed (n=12) or not (n=24) - had to choose a route of delivery for 10 clinical cases of women with a single uterine scar and a tight pelvis. The "routine pelvimetry" group had pelvimetry results. The group "no pelvimetry" became aware of pelvimetry results as a second step and had to indicate whether this information changed or not their management. The measurement of the inter-observer variability was estimated by estimating the proportion of agreement according to Grant method.


RESULTS
The proportion of agreements of an attempted vaginal delivery between obstetricians in the group "routine pelvimetry" was 64.7% (95% CI [61-68.5]) and 97.3% (95% CI [96.4 to 98.3]) in the group "no pelvimetry", prior knowledge of pelvimetry results. An attempted vaginal delivery was decided in 77.5% versus 98.7% (P<0.001). After knowledge of pelvimetry results in the group "no pelvimetry" had, the number of attempted vaginal deliver was not different (77.5% vs. 78%, P=0.920).


CONCLUSIONS
In women with one previous cesarean section, in case of tight pelvis discovered after pelvimetry, inter-observer variability of decision concerning the route of delivery is increased. Centers that choose to continue using the routine pelvimetry should develop procedures to limit this variability.
Maternité Port-Royal, hôpital Cochin Broca Hôtel-Dieu, DHU risques et grossesse, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France. Electronic address: mathilde_bourdon@hotmail.com.
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Bourdon
Département de gynécologie-obstétrique, hôpital Beaujon, DHU risques et grossesse, Assistance publique-Hôpitaux de Paris, 92110 Clichy, France.
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Ceccaldi
Département de gynécologie-obstétrique, hôpital Louis-Mourier, DHU risques et grossesse, Assistance publique-Hôpitaux de Paris, 92700 Colombes, France.
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Girard
Département de gynécologie-obstétrique, hôpital Bichat, DHU risques et grossesse, Assistance publique-Hopitaux de Paris, 75018 Paris, France.
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Koskas
Maternité Port-Royal, hôpital Cochin Broca Hôtel-Dieu, DHU risques et grossesse, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France.
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Goffinet
Maternité Port-Royal, hôpital Cochin Broca Hôtel-Dieu, DHU risques et grossesse, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France.
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Le Ray
D000328:Adult; D017604:Cesarean Section, Repeat / Q000379:methods* / Q000592:standards; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D015588:Observer Variation; D010387:Pelvimetry / Q000379:methods* / Q000592:standards; D016064:Vaginal Birth after Cesarean / Q000379:methods* / Q000592:standards
Delivery; Inter-observer variability; Modalité d’accouchement; Pelvimetry; Pelvimétrie; Previous cesarean section; Utérus cicatriciel; Variabilité inter-observateur