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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, Joachim W.

Editorial Board Member: / Bancalari, Eduardo / Milner, Anne / Genc, Mehmet R. / Chervenak, Frank A. / Chappelle, Joseph / Bergmann, Renate L. / Bernardes, J.F. / Bevilacqua, G. / Blickstein, Isaac / Cabero Roura, Luis / Carbonell-Estrany, Xavier / Carrera, Jose M. / D`Addario, Vincenzo / D'Alton, MD, Mary E. / Dimitrou, G. / Grunebaum, Amos / Hentschel, Roland / Köpcke, W. / Kawabata, Ichiro / Keirse, Marc J.N.C. / Kurjak M.D., Asim / Lee, Ben H. / Levene, Malcolm / Lockwood, Charles J. / Marsal, Karel / Makatsariya, Alexander / Nishida, Hiroshi / Papp, Zoltán / Pejaver, Ranjan Kumar / Pooh, Ritsuko K. / Romero, Roberto / Saugstad, Ola D. / Schenker, Joseph G. / Sen, Cihat / Seri, Istvan / Vetter, Klaus / Winn, Hung N. / Young, Bruce K. / Zimmermann, Roland

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Online
ISSN
1619-3997
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In This Section
Volume 33, Issue 3 (May 2005)

Issues

Visual analysis of antepartum fetal heart rate tracings: inter- and intra-observer agreement and impact of knowledge of neonatal outcome

Francesc Figueras
  • Department of Obstetrics, Hospital Clinic, Barcelona, Spain
/ Sonia Albela
  • Department of Obstetrics, Hospital Clinic, Barcelona, Spain
/ Silvana Bonino
  • Department of Obstetrics, Hospital Clinic, Barcelona, Spain
/ Montse Palacio
  • Department of Obstetrics, Hospital Clinic, Barcelona, Spain
/ Enrique Barrau
  • Department of Obstetrics, Hospital Clinic, Barcelona, Spain
/ Sandra Hernandez
  • Department of Obstetrics, Hospital Clinic, Barcelona, Spain
/ Carme Casellas
  • Department of Obstetrics, Hospital Clinic, Barcelona, Spain
/ Oriol Coll
  • Department of Obstetrics, Hospital Clinic, Barcelona, Spain
/ Vicenç Cararach
  • Department of Obstetrics, Hospital Clinic, Barcelona, Spain
Published Online: 2005-07-05 | DOI: https://doi.org/10.1515/JPM.2005.044

Abstract

Objective: To evaluate the inter- and intra-observer agreement of visual analysis of fetal heart rate tracing and to evaluate the bias introduced by knowledge of perinatal outcome in this interpretation.

Methods: One hundred tracings were independently analyzed by four observers. In a second study period, two observers re-analysed the 100 tracings in order to evaluate intra-observer agreement. The other two observers re-analyzed the tracings, which were labelled with fictitious perinatal outcome to evaluate the impact of this information on reliability. Agreement was analyzed by means of the proportion of agreement for qualitative parameters and the inter- and intra-class correlation coefficient for quantitative data.

Results: Poor agreement was found for quantitative variability, low variability category and number of decelerations. Moderate agreement was observed for baseline, normal variability category and number of accelerations. Fetal heart rate variability and number of accelerations and decelerations were found to be significantly influenced by clinical information of perinatal outcome. Biased observers showed lower reliability than unbiased ones.

Conclusion: Visual assessment of fetal heart rate tracings is unreliable due to low rates of agreement between and within observers. Only qualitative classification such as normal baseline and normal variability showed good agreement. Knowledge of clinical information introduces subjectivity to the visual analysis, leading to a negative impact on reliability.

Keywords: Fetal heart rate; reliability; reproducibility.

References

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About the article

Corresponding author: Francesc Figueras, MD, Hospital Clinic, Department of Obstetrics, Sabino de Arana 1, 08034 Barcelona/Spain. Tel.: +34 93 227 56 00 Fax: +34 93 227 56 00 E-mail:


Received: October 12, 2004

Revised: February 8, 2005

Accepted: February 11, 2005

Published Online: 2005-07-05

Published in Print: 2005-05-01



Citation Information: Journal of Perinatal Medicine, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/JPM.2005.044. Export Citation

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