Visual analysis of antepartum fetal heart rate tracings: inter- and intra-observer agreement and impact of knowledge of neonatal outcome
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Francesc Figueras
Abstract
Objective: To evaluate the inter- and intra-observer agreement of visual analysis of fetal heart rate tracing and to evaluate the bias introduced by knowledge of perinatal outcome in this interpretation.
Methods: One hundred tracings were independently analyzed by four observers. In a second study period, two observers re-analysed the 100 tracings in order to evaluate intra-observer agreement. The other two observers re-analyzed the tracings, which were labelled with fictitious perinatal outcome to evaluate the impact of this information on reliability. Agreement was analyzed by means of the proportion of agreement for qualitative parameters and the inter- and intra-class correlation coefficient for quantitative data.
Results: Poor agreement was found for quantitative variability, low variability category and number of decelerations. Moderate agreement was observed for baseline, normal variability category and number of accelerations. Fetal heart rate variability and number of accelerations and decelerations were found to be significantly influenced by clinical information of perinatal outcome. Biased observers showed lower reliability than unbiased ones.
Conclusion: Visual assessment of fetal heart rate tracings is unreliable due to low rates of agreement between and within observers. Only qualitative classification such as normal baseline and normal variability showed good agreement. Knowledge of clinical information introduces subjectivity to the visual analysis, leading to a negative impact on reliability.
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Articles in the same Issue
- Pregnancy outcome of euploid fetuses with increased nuchal translucency: how bad is the news?
- Cerebral edema on MRI in severe preeclamptic women developing eclampsia
- Smoking during pregnancy and bulimia nervosa in offspring
- Stimulation of hCG protein and mRNA in first trimester villous cytotrophoblast cells in vitro by glycodelin A
- Umbilical artery Doppler and umbilical cord pH at birth in small-for-gestational-age fetuses: valid estimate of their relationship
- Hemodynamics of the renal artery and descending aorta in fetuses with renal disease using color Doppler ultrasound – longitudinal comparison to normal fetuses
- Echocardiographic measurements in infants of diabetic mothers and macrosomic infants of nondiabetic mothers
- Obstetric and neonatal outcomes in apparently isolated mild fetal ventriculomegaly
- Visual analysis of antepartum fetal heart rate tracings: inter- and intra-observer agreement and impact of knowledge of neonatal outcome
- Multiple positive results during a neonatal screening program: a retrospective analysis of incidence, clinical implications and outcomes
- Thrombocytopoiesis in healthy term newborns
- Infected neonatal cephalohematomas caused by anaerobic bacteria
- Endothelin-1 concentrations in cord blood of neonates with meconium-stained amniotic fluid
- Fetal alcohol syndrome and pyloric stenosis: alcohol induced or an association?
- Course of pregnancy and birth in a patient with Bernard-Soulier syndrome – a case report
