Journal
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
Volume 199, Issue 6, Pages -Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.ajog.2008.06.027
Keywords
cesarean delivery; interobserver variability; nonreassuring fetal heart tracing; umbilical arterial pH < 7.00
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OBJECTIVE: We determined interobserver variability in the classification of fetal heart rate ( FHR) tracing with periodic deceleration as being reassuring or nonreassuring and in the ability to predict emergency cesarean delivery ( ECD) or umbilical arterial pH < 7.00. STUDY DESIGN: Five clinicians reviewed 100 FHR tracings 1 hour before abnormalities and, if applicable, the hour before delivery. We calculated weighted Kappa coefficients ( WKC) to assess interobserver variability and likelihood ratio of FHR tracing to identify ECD and low pH. RESULTS: Among 100 parturients, 46% of the women had ECD, and 2% of the women had low pH. The WKC for the classification of the FHR tracing as reassuring or nonreassuring in early labor was -0.12 and before delivery was 0.15. The WKC for ECD was 0.26 and for low pH was 0.21. The likelihood ratio for these 2 outcomes was < 2.0. CONCLUSION: There was poor agreement among the clinicians who classified FHR as reassuring vs nonreassuring; they could not identify which parturient would have ECD or a newborn infant with low pH.
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