Service de Gynécologie Obstétrique, Assistance Publique Hôpitaux de Paris - Hôpital Beaujon, 100 boulevard du Général Leclerc, Clichy La Garenne, France.
Université Paris Cité, 75006, Paris, France.
BMC Pregnancy Childbirth. 2024 Feb 14;24(1):136. doi: 10.1186/s12884-024-06322-4.
While the effectiveness of cardiotocography in reducing neonatal morbidity is still debated, it remains the primary method for assessing fetal well-being during labor. Evaluating how accurately professionals interpret cardiotocography signals is essential for its effective use. The objective was to evaluate the accuracy of fetal hypoxia prediction by practitioners through the interpretation of cardiotocography signals and clinical variables during labor.
We conducted a cross-sectional online survey, involving 120 obstetric healthcare providers from several countries. One hundred cases, including fifty cases of fetal hypoxia, were randomly assigned to participants who were invited to predict the fetal outcome (binary criterion of pH with a threshold of 7.15) based on the cardiotocography signals and clinical variables. After describing the participants, we calculated (with a 95% confidence interval) the success rate, sensitivity and specificity to predict the fetal outcome for the whole population and according to pH ranges, professional groups and number of years of experience. Interobserver agreement and reliability were evaluated using the proportion of agreement and Cohen's kappa respectively.
The overall ability to predict a pH level below 7.15 yielded a success rate of 0.58 (95% CI 0.56-0.60), a sensitivity of 0.58 (95% CI 0.56-0.60) and a specificity of 0.63 (95% CI 0.61-0.65). No significant difference in the success rates was observed with respect to profession and number of years of experience. The success rate was higher for the cases with a pH level below 7.05 (0.69) and above 7.20 (0.66) compared to those falling between 7.05 and 7.20 (0.48). The proportion of agreement between participants was good (0.82), with an overall kappa coefficient indicating substantial reliability (0.63).
The use of an online tool enabled us to collect a large amount of data to analyze how practitioners interpret cardiotocography data during labor. Despite a good level of agreement and reliability among practitioners, the overall accuracy is poor, particularly for cases with a neonatal pH between 7.05 and 7.20. Factors such as profession and experience level do not present notable impact on the accuracy of the annotations. The implementation and use of a computerized cardiotocography analysis software has the potential to enhance the accuracy to detect fetal hypoxia, especially for ambiguous cardiotocography tracings.
尽管胎心监护在降低新生儿发病率方面的有效性仍存在争议，但它仍然是评估分娩期间胎儿健康状况的主要方法。评估专业人员如何准确解读胎心监护信号对于其有效使用至关重要。本研究旨在评估通过解读胎心监护信号和临床变量，专业人员预测胎儿缺氧的准确性。
我们进行了一项横断面在线调查，涉及来自多个国家的 120 名产科医疗保健提供者。将 100 例病例（包括 50 例胎儿缺氧病例）随机分配给参与者，邀请他们根据胎心监护信号和临床变量预测胎儿结局（pH 值的二进制标准为 7.15）。在描述参与者后，我们计算了（置信区间为 95%）整个人群以及根据 pH 值范围、专业组别和工作年限预测胎儿结局的成功率、敏感性和特异性。使用一致性比例和 Cohen's kappa 分别评估观察者间一致性和可靠性。
预测 pH 值低于 7.15 的总体能力产生了 0.58 的成功率（95%置信区间为 0.56-0.60）、0.58 的敏感性（95%置信区间为 0.56-0.60）和 0.63 的特异性（95%置信区间为 0.61-0.65）。专业和工作年限对成功率没有显著影响。与 pH 值在 7.05 到 7.20 之间的病例（0.48）相比，pH 值低于 7.05（0.69）和高于 7.20（0.66）的病例的成功率更高。参与者之间的一致性比例较高（0.82），总体 Kappa 系数表明可靠性较高（0.63）。
使用在线工具使我们能够收集大量数据来分析专业人员在分娩期间如何解读胎心监护数据。尽管专业人员之间的一致性和可靠性水平较高，但整体准确性较差，特别是对于 pH 值在 7.05 到 7.20 之间的新生儿。专业和经验水平等因素对注释的准确性没有显著影响。使用计算机化胎心监护分析软件有可能提高检测胎儿缺氧的准确性，特别是对于胎心监护图不明确的情况。
