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

• Type: Article in International Scientific Journal
• Date: 2017

Authors

Santo, S (Author) Other; Ayres de Campos, D (Author) Other; Cristina Costa Santos (Author) FMUP; Schnettler, W (Author) Other; Ugwumadu, A (Author) Other; Da Graca, LM (Author) Other

Journal

Title: Acta Obstetricia et Gynecologica Scandinavica

Vol. 96

Pages: 166-175

ISSN: 0001-6349

Publisher: Wiley-Blackwell

Indexing

ISI Web of Knowledge - 32 Citations

Other information

Authenticus ID: P-00M-GKY

DOI: 10.1111/aogs.13064

Abstract (EN): IntroductionOne 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 methodsA 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 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. ResultsCardiotocography 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 ( = 0.37, 95% confidence interval 0.31-0.43), and National Institute for Health and Care Excellence ( = 0.33, 95% confidence interval 0.28-0.39) than with American College of Obstetrics and Gynecology ( = 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%). ConclusionsWith 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 trend towards higher sensitivity, and lower specificity in prediction of acidemia.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 10