ISSN 2736-1594
International Journal of Obstetrics and Gynecology ISSN 2326-7234 Vol. 6 (3), pp. 211-218, March, 2018. © International Scholars Journals
Full Length Research Paper
Interobserver agreement and reliability in intrapartum cardiotocography interpretation, using the 2015 FIGO consensus guidelines
Louise PARET1,2, Virginie EHLINGER1, Catherine ARNAUD1 and Christophe VAYSSIERE1,2
1Inserm, UMR1027, team SPHERE, Toulouse, France.
2Département de gynécolgie-obstétrique, hôpital Paule-de-Viguier, CHU de Toulouse, France.
Corresponding author E-mail: [email protected]; Tel. +33567771282
Accepted 05 December, 2017
Abstract
To assess interobserver reliability and agreement in the classification of cardiotocograms (CTGs) according to the 2015 revision of the FIGO (International Federation of Gynecology and Obstetrics) CTG classification. Six observers (3 obstetricians and 3 midwives) applied the 2015 FIGO guidelines and independently interpreted 60 intrapartum CTGs, randomly selected after stratification for arterial umbilical pH (pHa) at birth: 1/3 with pHa>7.15, 1/3 with pHa=7.05-7.15, and 1/3 with metabolic acidosis defined by pHa<7.05 and base deficit>10 mmol/L. Interobserver reliability was assessed by the Fleiss kappa coefficient and interobserver agreement by the proportion of agreement (Pa), calculated according to Grant. The overall interobserver reliability was good (kappa=0.62, 95%CI=0.52-0.73). Interobserver agreement was good for CTGs classified as normal by the observers (Pa=71.5%, 95%CI=67.5-75.2), moderate for those classified as pathological (Pa=57.4%, 95%CI=51.3-63.5) and poor for those classified as suspicious (Pa=36.4%, 95%CI=30.9-41.9). Interobserver reliability was good for baseline, moderate for variability assessment and presence of decelerations, but poor for classifying the decelerations. Results did not differ significantly between obstetricians and midwives. Application of this FIGO classification produced good interobserver reliability and agreement on CTG classification overall, but poor reliability for suspicious CTGs and for determination of the type of deceleration.
Keywords: Fetal heart rate, cardiotocography, interobserver variability, interobserver agreement, reliability, reproducibility.