Inter-observer variation in assessment of 845 labour admission tests: comparison between midwives and obstetricians in the clinical setting and two experts

Blix, E

doi:10.1016/s1470-0328(02)02105-5

Cited by 27 publications

(51 citation statements)

References 8 publications

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“…Other studies evaluating the reproducibility of CTG analysis using the FIGO and ACOG guidelines have shown that there is a fair to good agreement in evaluation of the baseline and accelerations, and a poor agreement regarding decelerations (3,16). It has also been reported that CTG classification as category I/normal is more reproducible than the other categories (4,5,(17)(18)(19). Our study demonstrates that this depends on the selected guidelines.…”

Section: Discussionsupporting

confidence: 48%

Agreement and accuracy using the FIGO, ACOG and NICE cardiotocography interpretation guidelines

Santo

Ayres‐de‐Campos

Costa-Santos

et al. 2017

Acta Obstet Gynecol Scand

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Introduction. 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. Material and 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 j 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 (j = 0.37, 95% confidence interval 0.31-0.43), and National Institute for Health and Care Excellence (j = 0.33, 95% confidence interval 0.28-0.39) than with American College of Obstetrics and Gynecology (j = 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

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Section: Discussionsupporting

confidence: 48%

Agreement and accuracy using the FIGO, ACOG and NICE cardiotocography interpretation guidelines

Santo

Ayres‐de‐Campos

Costa-Santos

et al. 2017

Acta Obstet Gynecol Scand

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“…The use of CTG is controversial, and its efficacy is being questioned 32,33. However, according to Swedish standards, CTG and FBS are the main tools for the assessment of fetal wellbeing during labour, and it is expected that they will be used 6,34…”

Section: Discussionmentioning

confidence: 99%

How often is a low Apgar score the result of substandard care during labour?

Berglund

Pettersson

Cnattingius

et al. 2010

BJOG

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ObjectiveTo increase our knowledge of the occurrence of substandard care during labour.DesignA population-based case–control study.SettingStockholm County.PopulationInfants born in the period 2004–2006 in Stockholm County.MethodsCases and controls were identified from the Swedish Medical Birth Register, had a gestational age of ≥33 complete weeks, had planned for a vaginal delivery, and had a normal cardiotocographic (CTG) recording on admission. We compared 313 infants with an Apgar score of <7 at 5 minutes of age with 313 randomly selected controls with a full Apgar score, matched for year of birth.Main outcome measureSubstandard care during labour.ResultsWe found that 62% of cases and 36% of controls were subject to some form of substandard care during labour. In half of the cases and in 12% of the controls, CTG was abnormal for ≥45 minutes before birth. Fetal blood sampling was not performed in 79% of both cases and controls, when indicated. Oxytocin was provided without signs of uterine inertia in 20% of both cases and controls. Uterine contractions were hyperstimulated by oxytocin in 29% of cases and in 9% of controls, and the dose of oxytocin was increased despite abnormal CTG in 19% and 6% of cases and controls, respectively. Assuming that substandard care is a risk factor for low Apgar score, we estimate that up to 42% of the cases could be prevented by avoiding substandard care.ConclusionsThere was substandard care during labour of two-thirds of infants with a low Apgar score. The main reasons for substandard care were related to misinterpretation of CTG, not acting on an abnormal CTG in a timely fashion and incautious use of oxytocin.

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“…The false-negative rate for the nonstress test is low ranging from 0.19% to 1%, and when assessing the interobserver variation the proportions of agreement for normal tests were high. 10 In contrast, the false-positive rate of a nonreactive nonstress test is as high as 55%, 11 and the proportions of agreement among experts for equivocal/ominous tests were poor. 10 Given that with an abnormal test result a fetus is more likely to be healthy than compromised, results must be used cautiously by clinicians, particularly at early gestational ages when delivery could result in significant morbidity.…”

Section: Nonstress Test (Nst)mentioning

confidence: 99%

Antepartum Evaluation of the Fetus and Fetal Well Being

OʼNeill

Thorp

2012

Clinical Obstetrics &Amp; Gynecology

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Despite widespread use of many methods of antenatal testing, limited evidence exists to demonstrate effectiveness at improving perinatal outcomes. An exception is the use of Doppler ultrasound in monitoring high-risk pregnancies thought to be at risk of placental insufficiency. Otherwise, obstetricians should proceed with caution and approach the initiation of a testing protocol by obtaining an informed consent. When confronted with an abnormal test, clinicians should evaluate with a second antenatal test and consider administering betamethasone, performing amniocentesis to assess lung maturity, and/or repeating testing to minimize the chance of iatrogenic prematurity in case of a healthy fetus.

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Inter-observer variation in assessment of 845 labour admission tests: comparison between midwives and obstetricians in the clinical setting and two experts

Cited by 27 publications

References 8 publications

Agreement and accuracy using the FIGO, ACOG and NICE cardiotocography interpretation guidelines

Agreement and accuracy using the FIGO, ACOG and NICE cardiotocography interpretation guidelines

How often is a low Apgar score the result of substandard care during labour?

Antepartum Evaluation of the Fetus and Fetal Well Being

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