Publication details
CTG intrapartum recording – agreement of expert obstetricians
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| Year of publication | 2015 |
| Type | Appeared in Conference without Proceedings |
| MU Faculty or unit | |
| Citation | |
| Description | Objectives: To evaluate intra and inter-observer agreement of obstetricians decision making and to relate their assessment to objective neonatal outcome measure such as pH. Material and Methods: Nine obstetricians annotated 638 recordings (552 unique). The evaluation of each record was divided into four stages (two 30 minutes windows in the I. stage, one window in the II. stage, labor evaluation). The intra/inter observer agreement was evaluated using proportion of agreement and kappa value. The sensitivity and specificity was evaluated with respect to different neonatal outcome measures (pH, base deficit and Apgar score). Results: The overall proportion of agreement was 48 % with 95 % confidence intervals (CI) (CI: 47–50). The proportions of agreement with respect to different classes were: 57 % (CI: 54–60) for normal, 46 % (CI: 44–48) for suspicious, 41 % (CI: 36–46) for pathological, and 15 % (CI: 10–21) for uninterpretable. The sensitivity and specificity of majority voting of clinicians with respect to umbilical artery pH (pH ? 7.05) 0.41 (CI: 0.35–0.47), 0.86 (CI: 0.82–0.90), and for base deficit (BDecf ? -12) were 0.50 (CI: 0.44–0.56), 0.86 (CI: 0.82–0.90), respectively. Conclusions: The reported intra/inter observer variability, even when evaluated in respect to objective measures of the neonatal outcome, is large and this holds irrespective of clinicians experience or work place. The results from this study support the agreement for introducing computer aided evaluation of CTG records that could standardize the process of CTG evaluation within the delivery ward. |