Interobserver agreement in analysis of cardiotocograms recorded during trial of labor after cesarean

• Published in: The journal of maternal-fetal & neonatal medicine 2019-11, Vol.32 (22), p.3778-3783
• Main Authors: Caning, M. M., Thisted, D. L. A., Amer-Wählin, I., Laier, G. H., Krebs, L.
• Format: Article
• Language: English
• Subjects: Acidosis - blood; Acidosis - diagnosis; Acidosis - epidemiology; Adult; Cardiotocography; Cardiotocography - statistics & numerical data; Case-Control Studies; Female; Fetal Distress - blood; Fetal Distress - diagnosis; Fetal Distress - epidemiology; Fetal Monitoring - methods; Fetal Monitoring - statistics & numerical data; Fleiss' kappa; Heart Rate, Fetal - physiology; Humans; interobserver agreement; Medicin och hälsovetenskap; Observer Variation; Predictive Value of Tests; Pregnancy; Retrospective Studies; Sensitivity and Specificity; Trial of Labor; trial of labor after cesarean (TOLAC); uterine rupture; Vaginal Birth after Cesarean - adverse effects; Vaginal Birth after Cesarean - methods; Vaginal Birth after Cesarean - statistics & numerical data
• ISSN: 1476-7058; 1476-4954; 1476-4954
• DOI: 10.1080/14767058.2018.1472225

Introduction: To examine interobserver agreement in intrapartum cardiotocography (CTG) classification in women undergoing trial of labor after a cesarean section (TOLAC) at term with or without complete uterine rupture. Materials and methods: Nineteen blinded and independent Danish obstetricians assessed CTG tracings from 47 women (174 individual pages) with a complete uterine rupture during TOLAC and 37 women (133 individual pages) with no uterine rupture during TOLAC. Individual pages with CTG tracings lasting at least 20 min were evaluated by three different assessors and counted as an individual case. The tracings were analyzed according to the modified version of the Federation of Gynaecology and Obstetrics (FIGO) guidelines elaborated for the use of STAN (ST-analysis). Occurrence of defined abnormalities was recorded and the tracings were classified as normal, suspicious, pathological, or preterminal. The interobserver agreement was evaluated using Fleiss' kappa. Results: Agreement on classification of a preterminal CTG was almost perfect. The interobserver agreement on normal, suspicious or pathological CTG was moderate to substantial. Regarding the presence of severe variable decelerations, the agreement was moderate. No statistical difference was found in the interobserver agreement between classification of tracings from women undergoing TOLAC with and without complete uterine rupture. Conclusions: The interobserver agreement on classification of CTG tracings from high-risk deliveries during TOLAC is best for assessment of a preterminal CTG and the poorest for the identification of severe variable decelerations.