Epstein Aaron J, Iriye Brian K, Hancock Lyle, Quilligan Edward J, Rumney Pamela J, Hancock Judy, Ghamsary Mark, Eakin Cortney M, Smith Cheryl, Wing Deborah A
Irvine Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Irvine, CA.
Women and Children's Hospital/Long Beach Memorial Medical Center; High Risk Pregnancy Center, Las Vegas, NV.
Am J Obstet Gynecol. 2016 Oct;215(4):488.e1-5. doi: 10.1016/j.ajog.2016.04.009. Epub 2016 Apr 16.
Contemporary interpretation of fetal heart rate patterns is based largely on the tenets of Drs Quilligan and Hon. This method differs from an older method that was championed by Dr Caldeyro-Barcia in recording speed and classification of decelerations. The latter uses a paper speed of 1 cm/min and classifies decelerations referent to uterine contractions as type I or II dips, compared with conventional classification as early, late, or variable with paper speed of 3 cm/min. We hypothesized that 3 cm/min speed may lead to over-analysis of fetal heart rate and that 1 cm/min may provide adequate information without compromising accuracy or efficiency.
The purpose of this study was to compare the Hon-Quilligan method of fetal heart rate interpretation with the Caldeyro-Barcia method among groups of obstetrics care providers with the use of an online interactive testing tool.
We deidentified 40 fetal heart rate tracings from the terminal 30 minutes before delivery. A website was created to view these tracings with the use of the standard Hon-Quilligan method and adjusted the same tracings to the 1 cm/min monitoring speed for the Caldeyro-Barcia method. We invited 2-4 caregivers to participate: maternal-fetal medicine experts, practicing maternal-fetal medicine specialists, maternal-fetal medicine fellows, obstetrics nurses, and certified nurse midwives. After completing an introductory tutorial and quiz, they were asked to interpret the fetal heart rate tracings (the order was scrambled) to manage and predict maternal and neonatal outcomes using both methods. Their results were compared with those of our expert, Edward Quilligan, and were compared among groups. Analysis was performed with the use of 3 measures: percent classification, Kappa, and adjusted Gwet-Kappa (P < .05 was considered significant).
Overall, our results show from moderate to almost perfect agreement with the expert and both between and within examiners (Gwet-Kappa 0.4-0.8). The agreement at each stratum of practitioner was generally highest for ascertainment of baseline and for management; the least agreement was for assessment of variability.
We examined the agreement of fetal heart rate interpretation with a defined set of rules among a number of different obstetrics practitioners using 3 different statistical methods and found moderate-to-substantial agreement among the clinicians for matching the interpretation of the expert. This implies that the simpler Caldeyro-Barcia method may perform as well as the newer classification system.
当代对胎儿心率模式的解读很大程度上基于奎利根博士和洪博士的原则。这种方法与卡尔代罗 - 巴尔西亚博士所倡导的一种旧方法在记录速度和减速分类方面有所不同。后者使用1厘米/分钟的纸速，并将与子宫收缩相关的减速分类为I型或II型下降，而传统分类则是在3厘米/分钟纸速下分为早期、晚期或变异型。我们假设3厘米/分钟的速度可能会导致对胎儿心率的过度分析，而1厘米/分钟可能在不影响准确性或效率的情况下提供足够的信息。
本研究的目的是使用在线交互式测试工具，在产科护理人员群体中比较洪 - 奎利根胎儿心率解读方法和卡尔代罗 - 巴尔西亚方法。
我们从分娩前最后30分钟的胎儿心率描记图中去除了识别信息。创建了一个网站，以使用标准的洪 - 奎利根方法查看这些描记图，并将相同的描记图调整为卡尔代罗 - 巴尔西亚方法的1厘米/分钟监测速度。我们邀请了2 - 4名护理人员参与：母胎医学专家、执业母胎医学专家、母胎医学研究员、产科护士和认证护士助产士。在完成入门教程和测验后，要求他们使用两种方法解读胎儿心率描记图（顺序打乱），以管理和预测母婴结局。将他们的结果与我们的专家爱德华·奎利根的结果进行比较，并在各群体之间进行比较。使用三种指标进行分析：分类百分比、卡帕值和调整后的格韦特 - 卡帕值（P <.05被认为具有统计学意义）。
总体而言，我们的结果显示与专家以及检查者之间和检查者内部的一致性从中度到几乎完美（格韦特 - 卡帕值为0.4 - 0.8）。在确定基线和管理方面，每个从业者层次的一致性通常最高；在评估变异性方面一致性最低。
我们使用三种不同的统计方法，在许多不同的产科从业者中检查了胎儿心率解读与一组明确规则的一致性，发现临床医生与专家的解读之间存在中度到高度的一致性。这意味着更简单的卡尔代罗 - 巴尔西亚方法可能与新的分类系统表现一样好。
