Garabedian C, Butruille L, Drumez E, Servan Schreiber E, Bartolo S, Bleu G, Mesdag V, Deruelle P, De Jonckheere J, Houfflin-Debarge V
University of Lille North of France, EA4489 Perinatal growth and environment, 59000 Lille, France; CHU Lille, Jeanne de Flandre Hospital, Department of obstetrics, 59000 Lille, France.
University of Lille North of France, EA4489 Perinatal growth and environment, 59000 Lille, France.
J Gynecol Obstet Hum Reprod. 2017 Feb;46(2):131-135. doi: 10.1016/j.jogoh.2016.11.002. Epub 2017 Jan 30.
Different classification of fetal heart rate (FHR) pattern have been proposed: FHR classified as either "reassuring" or "non-reassuring", the National Institute of Child Health and Human Development (NICHD) published in 2008 a 3-tier system, the French College of Gynecology and Obstetrics (CNGOF) recommended in 2013 a 5-tier system and recently in 2015, the Federation International of Gynecology and Obstetrics (FIGO) proposed a new classification based on a 3-tier system. Our objective was to assess the inter-observer reliability of these 4 existing classifications.
Four observers reviewed 100 FHR without clinical information. FHR were obtained from term singleton pregnancies. Fetal heart rate patterns were classified by one 2-tier ("reassuring vs. non-reassuring"), two 3-tier (NICHD 2008 and FIGO 2015), and one 5-tier (CNGOF 2013) fetal heart classifications.
The global agreement between observers was moderate for each classification: 0.58 (0.40-0.74) for the 2-tier, 0.48 (0.37-0.58) for the NICHD 2008, 0.58 (0.53-0.63) for the CNGOF 2013 and 0.59 (0.49-0.67) for the FIGO 2015 classification. When FHR was classified as reassuring, it was classified as normal in 85.5% for the NICHD 2008 and in 94.5% for the FIGO 2015. For the CNGOF 2013, 65.0% were classified as normal and 32.5% as quasi normal. There was strong concordance between FIGO category I and "reassuring" FHR (kappa=0.95).
Inter-observer agreement of FHR interpretation is moderate whatever the classification used. To evaluate the superior interest of one classification, it will be interesting to compare their impact on need of second line techniques and on neonatal outcome.
已提出不同的胎儿心率（FHR）模式分类方法：FHR分为“令人安心的”或“令人不安的”，美国国家儿童健康与人类发展研究所（NICHD）于2008年发布了一个三层系统，法国妇产科学会（CNGOF）在2013年推荐了一个五层系统，最近在2015年，国际妇产科联合会（FIGO）基于一个三层系统提出了一种新的分类方法。我们的目的是评估这4种现有分类方法的观察者间可靠性。
4名观察者在无临床信息的情况下对100例FHR进行了评估。FHR取自足月单胎妊娠。胎儿心率模式通过一种两层（“令人安心的与令人不安的”）、两种三层（NICHD 2008和FIGO 2015）以及一种五层（CNGOF 2013）胎儿心率分类方法进行分类。
每种分类方法观察者间的总体一致性为中等：两层分类法为0.58（0.40 - 0.74），NICHD 2008为0.48（0.37 - 0.58），CNGOF 2013为0.58（0.53 - 0.63），FIGO 2015分类法为0.59（0.49 - 0.67）。当FHR被分类为令人安心的时，在NICHD 2008中85.5%被分类为正常，在FIGO 2015中94.5%被分类为正常。对于CNGOF 2013，65.0%被分类为正常，32.5%被分类为准正常。FIGO I类与“令人安心的”FHR之间存在高度一致性（kappa = 0.95）。
无论使用哪种分类方法，FHR解读的观察者间一致性均为中等。为了评估一种分类方法的更高优势，比较它们对二线技术需求和新生儿结局的影响将是很有意思的。
