Intra- and interobserver variability of intrapartum cardiotocography: a multicenter study comparing the FIGO classification with computer analysis software.

OBJECTIVE: To evaluate and compare the computer analyzing software system with subjective interpretation using the FIGO classification of intrapartum cardiotocograms.
METHODS: Twenty-four obstetricians and 19 midwives from 3 hospitals [19 junior (≤3 years) and 24 senior (>3 years) experience] participated in this study. Forty-three doctors and midwives interpreted intrapartum cardiotocographic (CTG) readings from 12 parturients without knowing the clinical outcome. Two CTG readings were repeated for evaluation of the intraobserver variability. Inter- and intraobserver agreement in CTG interpretation using the FIGO score and the computer analyzing software was assessed via proportions of agreement (Pa), with 95% confidence intervals. The level of inter- and intraobserver agreement was analyzed by calculating Pa values for CTG baseline, variability, accelerations and decelerations.
RESULTS: In total, for all parameters of the FIGO classification, Pa was very low. The highest 95% confidence level of Pa was found for the baseline parameter (0.49-1.01), and the lowest for the parameter acceleration. No significant difference was seen between obstetricians and midwives as well as between junior and senior experience. In assessments of normal cases, the Pa were significantly higher than in pathological readings.
CONCLUSION: Computer analyzing software can reduce the high inter- and intraobserver variability; however, further studies are needed to find out whether this can improve fetal outcome and reduce the number of Cesarean sections.