Interobserver Reliability of Fetal Heart Rate Pattern Interpretation Using NICHD Definitions

Aaron J. Epstein; Sara Twogood; Richard H. Lee; Neisha Opper; Anna Beavis; David A. Miller

doi:10.1055/s-0032-1326991

American Journal of Perinatology, Table of Contents

Am J Perinatol 2013; 30(06): 463-468
DOI: 10.1055/s-0032-1326991

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Interobserver Reliability of Fetal Heart Rate Pattern Interpretation Using NICHD Definitions

Aaron J. Epstein

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine, Orange, California

,

Sara Twogood

²Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, California

,

Richard H. Lee

²Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, California

,

Neisha Opper

²Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, California

,

Anna Beavis

,

David A. Miller

²Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, California

› Author Affiliations

Abstract

Objective To evaluate the interobserver reliability of fetal heart rate (FHR) pattern definition and interpretation assessed by physicians at various levels of training using standard Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) definitions and standard principles of interpretation.

Study Design We conducted an interrater reliability study of the intrapartum FHR tracings of 32 singleton term pregnancies at Los Angeles County–University of Southern California (LAC + USC) Medical Center. Analysis included the 5 hours immediately preceding delivery, divided into 10- minute segments. A medical student, resident, and three attending physicians evaluated the same set of FHR tracings. Interobserver agreement was assessed using the free-marginal kappa coefficient.

Results Reviewers demonstrated substantial to excellent agreement on baseline rate (κ = 0.97), moderate variability (κ = 0.80), accelerations (κ = 0.62), decelerations (κ = 0.63), category (κ = 0.68), and the ability to identify the presence of either moderate variability or accelerations (κ = 0.82).

Conclusions Interobserver agreement was significantly higher on all components of FHR definition and interpretation than previously expected. Standardization of FHR definitions and interpretation may improve interobserver reliability and patient safety.

Keywords

fetal heart monitoring - interobserver reliability - NICHD

Full Text

References

References
1 National Institute of Child Health and Human Development Research Planning Workshop. Electronic fetal heart rate monitoring: research guidelines for interpretation. Am J Obstet Gynecol 1997; 177: 1385-1390
2 Clark SL, Hankins GDV. Temporal and demographic trends in cerebral palsy—fact and fiction. Am J Obstet Gynecol 2003; 188: 628-633
3 Nielsen PV, Stigsby B, Nickelsen C, Nim J. Intra- and inter-observer variability in the assessment of intrapartum cardiotocograms. Acta Obstet Gynecol Scand 1987; 66: 421-424
4 Beaulieu MD, Fabia J, Leduc B , et al. The reproducibility of intrapartum cardiotocogram assessments. Can Med Assoc J 1982; 127: 214-216
5 American College of Obstetricians and Gynecologists. Intrapartum Fetal Heart Monitoring: Nomenclature, Interpretation, and General Management Principles: ACOG practice bulletin: No. 106. Washington, DC: The College; 2009
6 Alfirevic Z, Devane D, Gyte GM. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev 2006; (3) CD006066
7 Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Munson ML. Births: final data for 2002. Natl Vital Stat Rep 2003; 52: 1-113
8 Thacker SB, Stroup D, Chang M. Continuous electronic heart rate monitoring for fetal assessment during labor. Cochrane Database Syst Rev 2001; (2) CD000063
9 American College of Obstetricians and Gynecologists Task Force on Neonatal Encephalopathy and Cerebral Palsy, American College of Obstetricians and Gynecologists, American Academy of Pediatrics. Neonatal Encephalopathy and Cerebral Palsy: Defining the Pathogenesis and Pathophysiology. Washington, DC: American College of Obstetricians and Gynecologists; 2003
10 MacLennan A. A template for defining a causal relationship between acute intrapartum events and cerebral palsy: international consensus statement. International Cerebral Palsy Task Force. Aust N Z J Obstet Gynaecol 2000; 40: 13-21
11 Macones GA, Hankins GD, Spong CY, Hauth J, Moore T. The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring: update on definitions, interpretation, and research guidelines. Obstet Gynecol 2008; 112: 661-666
12 Chauhan SP, Klauser CK, Woodring TC, Sanderson M, Magann EF, Morrison JC. Intrapartum nonreassuring fetal heart rate tracing and prediction of adverse outcomes: interobserver variability. Am J Obstet Gynecol 2008; 199: 623 , e1–e5
13 Wolfberg AJ, Derosier DJ, Roberts T , et al. A comparison of subjective and mathematical estimations of fetal heart rate variability. J Matern Fetal Neonatal Med 2008; 21: 101-104
14 Brennan RL, Prediger DJ. Coefficient kappa: some uses, misuses, and alternatives. Educ Psychol Meas 1981; 41: 687-699
15 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174
16 Jackson M, Holmgren CM, Esplin MS, Henry E, Varner MW. Frequency of fetal heart rate categories and short-term neonatal outcome. Obstet Gynecol 2011; 118: 803-808
17 Blackwell SC, Grobman WA, Antoniewicz L, Hutchinson M, Gyamfi Bannerman C. Interobserver and intraobserver reliability of the NICHD 3-Tier Fetal Heart Rate Interpretation System. Am J Obstet Gynecol 2011; 205: 378 , e1–e5