Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, MD, FRCOG, Joachim W.

Ed. by Bancalari, Eduardo / Chappelle, Joseph / Chervenak, Frank A. / D'Addario , Vincenzo / Genc, Mehmet R. / Greenough, Anne / Grunebaum, Amos / Konje, Justin C. / Kurjak M.D., Asim / Romero, Roberto / Zalud, Ivica

9 Issues per year

IMPACT FACTOR 2017: 1.558
5-year IMPACT FACTOR: 1.653

CiteScore 2017: 1.26

SCImago Journal Rank (SJR) 2017: 0.594
Source Normalized Impact per Paper (SNIP) 2017: 0.684

See all formats and pricing
More options …
Volume 34, Issue 4


Intrapartum cardiotocography – the dilemma of interpretational variation

Outi Palomäki / Tiina Luukkaala / Riikka Luoto / Risto Tuimala
Published Online: 2006-07-19 | DOI: https://doi.org/10.1515/JPM.2006.057


Objective: To evaluate and compare interobserver variation in interpretation of intrapartum cardiotocograms.

Subjects: Fifteen senior (experience >4 years) and 16 junior (experience ≤4 years) obstetricians from 10 delivery units.

Design: Thirty-one obstetricians interpreted intrapartum cardiotocographic (CTG) readings from 22 parturients.

Methods: Inter-observer agreement in CTG interpretation and decision-making was assessed via proportions of agreement (Pa), with 95% confidence intervals (CI).

Main outcome measures: The level of inter-observer agreement was analyzed by calculating Pa values for CTG baseline, variability, early, variable and late decelerations, uterine tonus, power of contractions, hypertonus and clinical decision.

Results: In assessments of normal cases the Pa were acceptable or good (0.63–0.82) as regards all CTG interpretation elements except for the power of contractions (0.24), but in assessments of abnormal cases the Pa values were lower (0.18–0.60). As regards clinical decisions, a higher Pa was found in cases without recommendation for intervention (0.63, 95% CI 0.62–0.64) than in cases with such recommendation (0.55, 95% CI 0.54–0.56). The Pa in the abnormal cases was better among senior than among junior obstetricians.

Conclusions: Inter-observer variation in interpretation of abnormal CTG readings and recommendations for intervention is relatively wide. To improve reliability, uniform classification and standardized training in CTG interpretation are needed, as well as increased use of computerized CTG.

Keywords: Cardiotocography; description; interobserver agreement; interpretation; intrapartum; labor

About the article

Corresponding author: Outi Palomäki, MD, PhD Senior Consultant Tampere University Hospital Department of Obstetrics Teiskontie 35 33521 Tampere/Finland

Received: September 7, 2005

Revised: February 1, 2006

Accepted: February 3, 2006

Published Online: 2006-07-19

Published in Print: 2006-08-01

Citation Information: Journal of Perinatal Medicine, Volume 34, Issue 4, Pages 298–302, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/JPM.2006.057.

Export Citation

Citing Articles

Here you can find all Crossref-listed publications in which this article is cited. If you would like to receive automatic email messages as soon as this article is cited in other publications, simply activate the “Citation Alert” on the top of this page.

Robert D. Eden, Mark I. Evans, David W. Britt, Shara M. Evans, and Barry S. Schifrin
The Journal of Maternal-Fetal & Neonatal Medicine, 2018, Page 1
Erika Gyllencreutz, Ke Lu, Kaj Lindecrantz, Pelle G. Lindqvist, Lennart Nordstrom, Malin Holzmann, and Farhad Abtahi
Acta Obstetricia et Gynecologica Scandinavica, 2018
Mark I. Evans, Robert D. Eden, David W. Britt, Shara M. Evans, and Barry S. Schifrin
The Journal of Maternal-Fetal & Neonatal Medicine, 2018, Page 1
Heather Thompson
British Journal of Midwifery, 2011, Volume 19, Number 10, Page 625
Meena Bhatia, Kamal R. Mahtani, David Nunan, and Aparna Reddy
International Journal of Gynecology & Obstetrics, 2017, Volume 138, Number 1, Page 89
Erika Gyllencreutz, Ingela Hulthén Varli, Pelle G. Lindqvist, and Malin Holzmann
Acta Obstetricia et Gynecologica Scandinavica, 2017, Volume 96, Number 4, Page 496
Susana Santo, Diogo Ayres-de-Campos, Cristina Costa-Santos, William Schnettler, Austin Ugwumadu, and Luís M. Da Graça
Acta Obstetricia et Gynecologica Scandinavica, 2017, Volume 96, Number 2, Page 166
Inês Nunes, Diogo Ayres-de-Campos, Austin Ugwumadu, Pina Amin, Philip Banfield, Antony Nicoll, Simon Cunningham, Paulo Sousa, Cristina Costa-Santos, and João Bernardes
Obstetrics & Gynecology, 2017, Volume 129, Number 1, Page 83
Elli Toivonen, Outi Palomäki, Heini Huhtala, and Jukka Uotila
BMC Pregnancy and Childbirth, 2016, Volume 16, Number 1
Malin Holzmann, Stina Wretler, and Lennart Nordström
Acta Obstetricia et Gynecologica Scandinavica, 2016, Volume 95, Number 10, Page 1097
Diogo Ayres-de-Campos, Austin Ugwumadu, Philip Banfield, Pauline Lynch, Pina Amin, David Horwell, Antonia Costa, Cristina Santos, João Bernardes, and Karl Rosen
BMC Pregnancy and Childbirth, 2010, Volume 10, Number 1
Tullio Ghi, Giovanni Morganelli, Federica Bellussi, Paola Rucci, Francesca Giorgetta, Nicola Rizzo, Tiziana Frusca, and Gianluigi Pilu
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2016, Volume 203, Page 297
Stina Wretler, Malin Holzmann, Sophie Graner, Pelle Lindqvist, Susanne Falck, and Lennart Nordström
BMC Pregnancy and Childbirth, 2016, Volume 16, Number 1
Kevin Jenniskens and Patricia A. Janssen
Journal of Obstetrics and Gynaecology Canada, 2015, Volume 37, Number 3, Page 207
Christine E. East, Stefan C. Kane, Mary-Ann Davey, C. Omar Kamlin, and Shaun P. Brennecke
BMC Pregnancy and Childbirth, 2015, Volume 15, Number 1
Laura Sabiani, Renaud Le Dû, Anderson Loundou, Claude d’Ercole, Florence Bretelle, Léon Boubli, and Xavier Carcopino
American Journal of Obstetrics and Gynecology, 2015, Volume 213, Number 6, Page 856.e1
Lauren M. Bullens, Pieter J. van Runnard Heimel, M. Beatrijs van der Hout-van der Jagt, and S. Guid Oei
Obstetrical & Gynecological Survey, 2015, Volume 70, Number 8, Page 524
Inês Nunes and Diogo Ayres-de-Campos
Best Practice & Research Clinical Obstetrics & Gynaecology, 2016, Volume 30, Page 68
Chandan Karmakar, Yoshitaka Kimura, Marimuthu Palaniswami, and Ahsan Khandoker
Biomedical Signal Processing and Control, 2015, Volume 21, Page 43
Leon Glass
Chaos: An Interdisciplinary Journal of Nonlinear Science, 2015, Volume 25, Number 9, Page 097603
S. Uccella, A. Cromi, G. F. Colombo, G. Bogani, J. Casarin, M. Agosti, and F. Ghezzi
Journal of Obstetrics and Gynaecology, 2015, Volume 35, Number 3, Page 241
Sayako Ikeda, Atsuko Okazaki, Ken Miyazaki, Kana Kihira, and Madoka Furuhashi
Journal of Obstetrics and Gynaecology Research, 2014, Volume 40, Number 5, Page 1274
Madalena D. Costa, William T. Schnettler, Célia Amorim-Costa, João Bernardes, Antónia Costa, Ary L. Goldberger, and Diogo Ayres-de-Campos
Early Human Development, 2014, Volume 90, Number 1, Page 67
S Uccella, A Cromi, GF Colombo, M Agosti, G Bogani, J Casarin, and F Ghezzi
BJOG: An International Journal of Obstetrics & Gynaecology, 2012, Volume 119, Number 13, Page 1657
Hasan Ocak and Huseyin Metin Ertunc
Neural Computing and Applications, 2013, Volume 23, Number 6, Page 1583
Atsuko Sadaka, Madoka Furuhashi, Hiroji Minami, Ken Miyazaki, Kana Yoshida, and Kaoru Ishikawa
The Journal of Maternal-Fetal & Neonatal Medicine, 2011, Volume 24, Number 12, Page 1465
S. Schiermeier, G. Westhof, A. Leven, H. Hatzmann, and J. Reinhard
Gynecologic and Obstetric Investigation, 2011, Volume 72, Number 3, Page 169
Julian T. Parer and Emily F. Hamilton
American Journal of Obstetrics and Gynecology, 2010, Volume 203, Number 5, Page 451.e1
Sean C. Blackwell, William A. Grobman, Leah Antoniewicz, Maria Hutchinson, and Cynthia Gyamfi Bannerman
American Journal of Obstetrics and Gynecology, 2011, Volume 205, Number 4, Page 378.e1
J. Spilka, V. Chudáček, M. Koucký, L. Lhotská, M. Huptych, P. Janků, G. Georgoulas, and C. Stylios
Biomedical Signal Processing and Control, 2012, Volume 7, Number 4, Page 350
D Ayres-de-Campos, D Arteiro, C Costa-Santos, and J Bernardes
BJOG: An International Journal of Obstetrics & Gynaecology, 2011, Volume 118, Number 8, Page 978
Andreas Gschliesser, Matthias Scheier, Hans Peter Colvin, Verena Barbieri, and Anton Bergant
Journal of Perinatal Medicine, 2010, Volume 38, Number 2
Petra C.A.M. Bakker, Suzanne Van Rijsiwijk, and Herman P. van Geijn
Journal of Perinatal Medicine, 2007, Volume 35, Number 6
Petra C.A.M. Bakker and Herman P. van Geijn
Journal of Perinatal Medicine, 2008, Volume 36, Number 1
Sven Schiermeier, Joscha Reinhard, Hendrike Hatzmann, Ralf C. Zimmermann, and Gregor Westhof
Journal of Perinatal Medicine, 2009, Volume 37, Number 5
Charlene E. THORNTON, Angela MAKRIS, Jane M. TOOHER, Robert F. OGLE, and Annemarie HENNESSY
Australian and New Zealand Journal of Obstetrics and Gynaecology, 2010, Volume 50, Number 5, Page 456
S Schiermeier, S Pildner von Steinburg, A Thieme, J Reinhard, M Daumer, M Scholz, W Hatzmann, and KTM Schneider
BJOG: An International Journal of Obstetrics & Gynaecology, 2008, Volume 115, Number 12, Page 1557

Comments (0)

Please log in or register to comment.
Log in