产时胎儿头部位置估计的观察者间一致性。
Interobserver agreement in intrapartum estimation of fetal head station.
作者信息
Buchmann Eckhart, Libhaber Elena
机构信息
Department of Obstetrics and Gynecology, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa.
出版信息
Int J Gynaecol Obstet. 2008 Jun;101(3):285-9. doi: 10.1016/j.ijgo.2007.11.020. Epub 2008 Jan 28.
OBJECTIVE
To determine interobserver agreement in estimation of fetal head station during labor, and the determinants of agreement.
METHODS
A prospective study of fetal head station in 508 women in term labor. Vaginal examination of station was performed by a researcher at the same time as clinicians performed routine intrapartum assessments of the participants. Station 0 was considered to represent engagement.
RESULTS
Station could be estimated by both the researcher and clinicians in 446 women (88%). The kappa statistic for agreement was 0.23 (95% confidence interval, 0.17-0.29). There was agreement in 166 cases (37%) and disagreement by 1 cm in 208 (47%) cases. Agreement was best (50%) when the researcher assessed the head at station minus 1. Multiple regression analysis showed that agreement was not influenced by level of experience of the attending clinicians, nor by obstetric factors.
CONCLUSION
Estimation of station as a method of determining the level of the fetal head in labor appears imprecise and poorly reproducible.
目的
确定分娩期间胎儿先露部位置估计的观察者间一致性及其一致性的决定因素。
方法
对508名足月分娩妇女的胎儿先露部位置进行前瞻性研究。研究人员在临床医生对参与者进行常规产时评估的同时进行阴道先露部位置检查。将先露部位置0视为入盆。
结果
446名妇女（88%）的先露部位置可由研究人员和临床医生共同估计。一致性的kappa统计量为0.23（95%置信区间，0.17 - 0.29）。166例（37%）达成一致，208例（47%）相差1厘米。当研究人员评估先露部位置为-1时，一致性最佳（50%）。多元回归分析表明，一致性不受主治临床医生经验水平的影响，也不受产科因素的影响。
结论
将先露部位置估计作为确定分娩时胎儿头部位置的一种方法似乎不准确且重复性差。
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