Santo Susana, Ayres-de-Campos Diogo, Costa-Santos Cristina, Schnettler William, Ugwumadu Austin, Da Graça Luís M
Department of Obstetrics and Gynecology, Santa Maria Hospital, Faculty of Medicine of Lisbon University, Lisbon, Portugal.
Department of Obstetrics and Gynecology, Medical School, University of Porto, S. João Hospital, Institute of Biomedical Engineering, Porto, Portugal.
Acta Obstet Gynecol Scand. 2017 Feb;96(2):166-175. doi: 10.1111/aogs.13064. Epub 2017 Jan 6.
One 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.
A 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 κ 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.
Cardiotocography 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 (κ = 0.37, 95% confidence interval 0.31-0.43), and National Institute for Health and Care Excellence (κ = 0.33, 95% confidence interval 0.28-0.39) than with American College of Obstetrics and Gynecology (κ = 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%).
With 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.
胎心监护报告的局限性之一是在描记解读中观察到的观察者间一致性一般。本研究使用国际妇产科联合会、美国妇产科医师学会和英国国家卫生与临床优化研究所的指南，比较了胎心监护解读的一致性、可靠性和准确性。
来自三个中心的27名临床医生对总共151份描记进行了评估，这些中心常规使用国际妇产科联合会、美国妇产科医师学会和英国国家卫生与临床优化研究所的指南。使用一致性比例和κ统计量评估观察者间一致性。评估分类为“病理性/III类”的描记对新生儿酸血症的预测准确性。对于所有测量指标，计算95%置信区间。
与美国妇产科医师学会（13%、81%、6%）相比，国际妇产科联合会（9%、52%、39%）和英国国家卫生与临床优化研究所（30%、33%、37%）的胎心监护分类分布更为分散。一致性最高的类别是美国妇产科医师学会的II类（一致性比例=0.73，95%置信区间0.70-0.76），一致性最低的是美国妇产科医师学会的I类和III类。国际妇产科联合会（κ=0.37，95%置信区间0.31-0.43）和英国国家卫生与临床优化研究所（κ=0.33，95%置信区间0.28-0.39）的可靠性显著高于美国妇产科医师学会（κ=0.15，95%置信区间0.10-0.21）；然而，所有这些仅代表轻微/尚可的可靠性。国际妇产科联合会和英国国家卫生与临床优化研究所在预测新生儿酸血症方面显示出比美国妇产科医师学会（32%）更高的敏感性趋势（分别为89%和97%），但后者的特异性显著更高（95%）。
根据美国妇产科医师学会的指南，II类一致性高，可靠性低，预测酸血症的敏感性低而特异性高。根据国际妇产科联合会和英国国家卫生与临床优化研究所的指南，可靠性更高，预测酸血症有更高的敏感性趋势，而特异性更低。
