Singhmor Priya, Ghuman Navdeep Kaur, Kathuria Priyanka, Sharma Charu, Jain Mayank, Shet Suma, Mathew Priya Susan, Singh Pratibha
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Jodhpur, India.
J Obstet Gynaecol India. 2025 Apr;75(Suppl 1):405-413. doi: 10.1007/s13224-024-02028-x. Epub 2024 Jul 13.
Assessment of accuracy, intra-observer and inter-observer and agreement for CTG interpretation utilizing NICE guidelines 2017.
This prospective observational study was completed at a tertiary-level hospital. 1650 CTG tracings were interpretations by 5 clinicians with various levels of clinical experience according to NICE 2017 CTG interpretation guidelines were analyzed. Inter-observer and intra-observer congruence was ascertained by employing Fleiss' kappa and Cohen's kappa using SPSS statistical software. Sensitivity, specificity, predictive values, likelihood ratios and overall accuracy of various CTG parameters for acidemia were computed.
Different CTG parameters had varied inter and intra-observer congruence which improved among clinicians with more than 5 years of experience. The best agreement was seen for baseline fetal heart ( = 0.678), and others like identification of variability pattern, type of decelerations and concerning features of variable decelerations had fair to only slight agreement. Again, various CTG parameters had very diverse predictive values for metabolic acidosis. Overall CTG category had a sensitivity, specificity and overall accuracy of 85.00%, 82.64% and 82.67%, respectively. As a single parameter variable deceleration with concerning characters surpassed all other CTG variables for the prediction of acidosis.
NICE 2017 guidelines for CTG interpretation were found to have fairly good predictive accuracy for acidemia. CTG had a high negative predictive value. A high level of non-correspondence in few CTG parameters as determining variability, identification of the deceleration type and concerning features probably point to the requirement for further objectivity while defining these parameters.
依据2017年英国国家卫生与临床优化研究所（NICE）指南评估产时胎心监护（CTG）解读的准确性、观察者内和观察者间的一致性。
这项前瞻性观察性研究在一家三级医院完成。根据2017年NICE的CTG解读指南，由5名具有不同临床经验水平的临床医生对1650份CTG描记图进行解读并分析。使用SPSS统计软件，通过Fleiss卡方检验和Cohen卡方检验确定观察者间和观察者内的一致性。计算各种CTG参数对酸血症的敏感性、特异性、预测值、似然比和总体准确性。
不同的CTG参数在观察者间和观察者内的一致性各不相同，在经验超过5年的临床医生中有所改善。基线胎心方面的一致性最佳（κ = 0.678），而其他方面，如变异性模式的识别、减速类型以及可变减速的相关特征，一致性仅为一般到轻微。此外，各种CTG参数对代谢性酸中毒的预测值差异很大。总体CTG分类的敏感性、特异性和总体准确性分别为85.00%、82.64%和82.67%。作为单一参数，具有相关特征的可变减速在酸中毒预测方面超过了所有其他CTG变量。
发现2017年NICE的CTG解读指南对酸血症具有相当好的预测准确性。CTG具有较高的阴性预测值。在确定变异性、减速类型识别和相关特征等少数CTG参数方面存在高度不一致，这可能表明在定义这些参数时需要进一步提高客观性。
