Buscicchio Giorgia, Gentilucci Lucia, Martorana Rossana, Martino Cristina, Tranquilli Andrea Luigi
Department of Clinical Sciences, Università Politecnica Marche , Via Corridoni 11 60123 Ancona AN , Italy.
J Matern Fetal Neonatal Med. 2012 Dec;25(12):2797-8. doi: 10.3109/14767058.2012.718391. Epub 2012 Sep 6.
The aim of this study was to assess reproducibility and clinical relevance of current guidelines on fetal heart rate interpretation in labor. Two obstetricians with comparable experience analyzed one hundred fetal heart rate tracings. One doctor made a first analysis using American College of Obstetricians and Gynecologists (ACOG) 2009 guideline's criteria; the other used National Institute for Health and Clinical Excellence (NICE) 2007 guideline's criteria; subsequently they repeated the evaluation crossing the guidelines used. The primary outcome of this experiment was to determine the time spent to evaluate the tracings, secondary outcomes were: the intraobserver concordance (concordance of the evaluation with the two systems for each investigator), the interobserver concordance (concordance between the interpretation given by each investigator) and. the concordance between operators' grading and actual outcome of labor. The interpretation of fetal heart rate tracings was longer using ACOG criteria. The intraobserver agreement was significant. The interobserver agreement was better using NICE guidelines. The same trend showed for the concordance between investigators' grading and actual outcomes There was more discordance in worse outcomes. Both guidelines are interesting and useful, but NICE seems easier to handle than ACOG.
本研究的目的是评估当前产时胎儿心率解读指南的可重复性和临床相关性。两位经验相当的产科医生分析了100份胎儿心率描记图。一位医生首先使用美国妇产科医师学会（ACOG）2009年指南的标准进行分析；另一位使用英国国家卫生与临床优化研究所（NICE）2007年指南的标准；随后他们交叉使用指南重复评估。本实验的主要结果是确定评估描记图所花费的时间，次要结果包括：观察者内一致性（每位研究者对两种系统评估的一致性）、观察者间一致性（每位研究者给出的解读之间的一致性）以及操作者分级与实际产程结果之间的一致性。使用ACOG标准解读胎儿心率描记图的时间更长。观察者内一致性显著。使用NICE指南时观察者间一致性更好。研究者分级与实际结果之间的一致性也呈现相同趋势，较差结果中的不一致性更多。两个指南都很有意义且有用，但NICE似乎比ACOG更易于操作。
