EVALUATION OF INTEROBSERVER AGREEMENT OF CARDIOTOCOGRAMS

Objective: To evaluate interobserver agreement in visual analysis of e ach cardiotocographic event. Methods: Three experts independently divi ded 16 antepartum and 17 intrapartum cardiotocograms into baseline seg ments, accelerations and decelerations, according to the FIGO guidelin es. Baseline segments were further classified as having normal, reduce d or increased variability and decelerations as early, late and variab le. Uterine activity was divided into tonus and contractions. Agreemen t was assessed by the proportions of agreement (pa) with 95% confidenc e intervals. Results: Reproducibility in assessment of baseline segmen ts with normal variability, accelerations and uterine activity was acc eptable (pa=0.56-0.71) whereas that of other segments was not (pa=0.14 -0.45). Conclusions: Analysis of most cardiotocographic events is poor ly reproducible, even when experts use the FIGO guidelines. This may b e explained by some still ambiguous guidelines, by eyeball limitations in evaluation of subtle events, and by the incapacity of busy clinici ans to assess complex and multiple cardiotocographic events in a syste matic and disciplined fashion. (C) 1997 International Federation of Gy necology and Obstetrics.