title: Agreement and accuracy using the FIGO, ACOG and NICE cardiotocography interpretation guidelines.
abstract: BACKGROUND
  One of the limitations reported with cardiotocography is the modest interobserver agreement observed in tracing interpretation. This study compared agreement, reliability and accuracy of cardiotocography interpretation using the International Federation of Gynecology and Obstetrics, American College of Obstetrics and Gynecology and National Institute for Health and Care Excellence guidelines.
  
  
  METHODS
  A total of 151 tracings were evaluated by 27 clinicians from three centers where International Federation of Gynecology and Obstetrics, American College of Obstetrics and Gynecology and National Institute for Health and Care Excellence guidelines were routinely used. Interobserver agreement was evaluated using the proportions of agreement and reliability with the κ statistic. The accuracy of tracings classified as "pathological/category III" was assessed for prediction of newborn acidemia. For all measures, 95% confidence interval were calculated.
  
  
  RESULTS
  Cardiotocography classifications were more distributed with International Federation of Gynecology and Obstetrics (9, 52, 39%) and National Institute for Health and Care Excellence (30, 33, 37%) than with American College of Obstetrics and Gynecology (13, 81, 6%). The category with the highest agreement was American College of Obstetrics and Gynecology category II (proportions of agreement = 0.73, 95% confidence interval 0.70-76), and the ones with the lowest agreement were American College of Obstetrics and Gynecology categories I and III. Reliability was significantly higher with International Federation of Gynecology and Obstetrics (κ = 0.37, 95% confidence interval 0.31-0.43), and National Institute for Health and Care Excellence (κ = 0.33, 95% confidence interval 0.28-0.39) than with American College of Obstetrics and Gynecology (κ = 0.15, 95% confidence interval 0.10-0.21); however, all represent only slight/fair reliability. International Federation of Gynecology and Obstetrics and National Institute for Health and Care Excellence showed a trend towards higher sensitivities in prediction of newborn acidemia (89 and 97%, respectively) than American College of Obstetrics and Gynecology (32%), but the latter achieved a significantly higher specificity (95%).
  
  
  CONCLUSIONS
  With American College of Obstetrics and Gynecology guidelines there is high agreement in category II, low reliability, low sensitivity and high specificity in prediction of acidemia. With International Federation of Gynecology and Obstetrics and National Institute for Health and Care Excellence guidelines there is higher reliability, a trend towards higher sensitivity, and lower specificity in prediction of acidemia.
authors.affiliation: Department of Obstetrics and Gynecology, Santa Maria Hospital, Faculty of Medicine of Lisbon University, Lisbon, Portugal.
authors.forename: Susana
authors.initials: S
authors.lastname: Santo
authors.affiliation: Department of Obstetrics and Gynecology, Medical School, University of Porto, S. João Hospital, Institute of Biomedical Engineering, Porto, Portugal.
authors.forename: Diogo
authors.initials: D
authors.lastname: Ayres-de-Campos
authors.affiliation: Department of Medical Informatics, Medical School, University of Porto, Porto, Portugal.
authors.forename: Cristina
authors.initials: C
authors.lastname: Costa-Santos
authors.affiliation: Center for Maternal Cardiac Care, TriHealth, Good Samaritan Hospital, Cincinnati, OH, USA.
authors.forename: William
authors.initials: W
authors.lastname: Schnettler
authors.affiliation: Department of Obstetrics & Gynecology, St George's Hospital, University of London, London, UK.
authors.forename: Austin
authors.initials: A
authors.lastname: Ugwumadu
authors.affiliation: Department of Obstetrics and Gynecology, Santa Maria Hospital, Faculty of Medicine of Lisbon University, Lisbon, Portugal.
authors.forename: Luís M
authors.initials: LM
authors.lastname: Da Graça
mesh_terms: D000138:Acidosis / Q000175:diagnosis*; D015148:Cardiotocography / Q000592:standards*; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D005315:Fetal Diseases / Q000175:diagnosis; D006340:Heart Rate, Fetal; D006801:Humans; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Agreement; cardiotocography; electronic fetal monitoring; guidelines; heart rate