Abbreviations: CTG, cardiotocography; FBS, fetal scalp blood sampling; STAN, ST waveform analysis of fetal electrocardiogram. Abstract Introduction: This study describes clinical routines for intrapartum fetal monitoring in Norway and compliance with national clinical recommendations. Material and methods: A national survey of all (n = 48) birth units in Norway, using a self-reporting questionnaire about fetal monitoring methods and devices available in the birth units, admission cardiotocography (CTG) use, intrapartum fetal monitoring methods for women with and without risk factors, the availability of fetal scalp blood sampling facilities, and umbilical cord blood sampling routines. Results: All birth units responded. They all had access to Pinard stethoscopes, handheld Doppler devices, and CTG. Half of the units used ST waveform analysis (STAN) as an adjunct to CTG. Furthermore, 23 of 48 units analyzed fetal blood samples and 43 of 48 umbilical cord blood gas samples. In 11 units, admission CTG was routinely offered to all women. No units used continuous CTG during labor in low-risk women. However, three units routinely used intermittent CTG during the first stage of labor. Three units used CTG without having access to fetal blood samples or STAN. Conclusions: Our findings indicate some deviations from clinical recommendations in the use of intrapartum fetal monitoring in Norway. Three units used intermittent CTG for women without risk factors. Almost one in four units routinely used admission CTG, despite national clinical recommendations. The lack of access to fetal blood samples or STAN in units using CTG is of concern. K E Y W O R D S admission cardiotocography, cardiotocography, fetal scalp blood sampling, intermittent auscultation, intrapartum fetal monitoring, ST waveform analysis, umbilical cord blood gas analysis
Introduction Fetal heart rate (FHR) monitoring is routine in intrapartum care worldwide and one of the most common obstetrical procedures. Intrapartum FHR monitoring helps assess fetal wellbeing and interpretation of the FHR help form decisions for clinical management and intervention. It relies on the observers' subjective assessments, with variation in interpretations leading to variations in intrapartum care. The purpose of this systematic review was to summarize and evaluate extant inter‐ and intrarater reliability research on the human interpretation of intrapartum FHR monitoring. Material and Methods We searched for the terms “fetal heart rate monitoring,” “interpretation agreement” and related concepts on Embase, Medline, Maternity and Infant Care Database and CINAHL. The last search was made on January 31, 2022. The protocol for the study was prospectively registered in PROSPERO (CRD42021260937). Studies that assess inter‐ and intrarater reliability and agreement of health professionals' intrapartum FHR monitoring were included and studies including other assessment of fetal wellbeing excluded. We extracted data in reviewer pairs using quality appraisal tool for studies of diagnostic reliability (QAREL) forms. The data retrieved from the studies are presented as narrative synthesis and in additional tables. Results Forty‐nine articles concerning continuous FHR monitoring were included in the study. For interrater reliability and agreement, in total 577 raters assessed 6315 CTG tracings. There was considerable heterogeneity in quality and measures across the included articles. We found higher reliability and agreement for the basic FHR features than for overall classification and higher agreement for intrarater reliability and agreement than for their interrater counterparts. Conclusions There is great variation in reliability and agreement measures for continuous intrapartum FHR monitoring, implying that intrapartum CTG should be used with caution for clinical decision making given its questionable reliability. We found few high‐quality studies and noted methodological concerns in the studies. We recommend a more standardized approach to future reliability studies on FHR monitoring.
Background Intrapartum foetal heart rate (FHR) monitoring helps assess foetal wellbeing. It relies on observers’ subjective assessments, with variation in interpretations leading to variations in intrapartum care. Objectives To summarize and evaluate inter- and intra-rater reliability research on human interpretation of intrapartum FHR monitoring. Search Strategy We searched for the terms ‘foetal heart rate monitoring’, ‘interpretation agreement’ and related concepts on Embase, Medline, Maternity & Infant Care Database and CINAHL. Last search was 31st January 2022. Selection Criteria We included studies that assess inter- and intra-rater reliability of health professionals’ intrapartum FHR monitoring and excluded studies including other assessment of foetal wellbeing. Data collection and analysis We extracted data in reviewer pairs using QAREL (quality appraisal tool for studies of diagnostic reliability) forms. We performed a random effect meta-analysis to present pooled estimates with 95% confidence intervals. Narrative synthesis reported results not appropriate for meta-analysis. Main results Forty-nine articles concerning continuous FHR monitoring were included, all with considerable heterogeneity in quality and measures. The pooled κ coefficient was 0.45 (95% CI 0.33-0.56) for FIGO (International Federation of Gynecology and Obstetrics) classifications. Conclusions There are few high-quality studies that evaluate inter- and intra-observer variations in intrapartum FHR monitoring. We found great variation in reliability measures and noted methodological concerns in the studies. Funding C. H. Engelhart received a PhD scholarship from the Norwegian Research Centre for Women’s Health at Oslo University Hospital. Keywords Inter-rater reliability and agreement, intra-rater reliability and agreement, foetal heart rate monitoring, systematic review, meta-analysis.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.