Intra- and interobserver agreement among obstetric experts in court regarding the review of abnormal fetal heart rate tracings and obstetrical management

Electronic fetal monitoring, cerebral palsy, and caesarean section: assumptions versus evidence

“…Experienced obstetricians had only mediocre agreement with one another in reading monitoring tracings, and when shown the same tracing months later agreed with their previous interpretations even less well. 19 The United States Preventive Services Task Force rated effectiveness of electronic fetal monitoring as grade D, the lowest grade possible. 12…”

“…Importantly, knowledge of neurological abnormality in a child with alleged birth injury influences interpretations of monitoring tracings and judgments about the appropriateness of the clinical care provided. [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] "Birth injury" lawsuits are among the most expensive of claims. Birth injury cases accounted for half of British NHS litigation costs in 2013, almost 20% of the total budget for maternity services.…”

Cerebral Palsy and Electronic Fetal Monitoring: Rearranging The Titanic’s Deck Chairs

“…As had been demonstrated for years [53,54] knowing that there is a poor patient outcome causes "experts" to be much more likely to criticize another obstetrician's management and find evidence of fetal asphyxia on heart rate tracings [53,55].…”

“…Decisions regarding C-sections were no better. One day experts advised immediate C-section, but days later, based on the same data, they advised vaginal delivery [4,[20][21][22]53].…”

Reliability in cardiotocography interpretation – impact of extended on‐site education in addition to web‐based learning: an observational study

“…Several studies have been conducted on both three‐tier and four‐tier classification systems. These studies have shown that the interpretation of CTG varies substantially between different obstetricians or midwives (inter‐observer reliability) and also varies in the same individual if the CTG trace is presented for interpretation with some time in between (intra‐observer reliability) . However, a more recent study from 2013 demonstrated a good inter‐observer reliability between physicians with a wide range of experience after they had completed a CTG examination before the study .…”