Intrapartum nonreassuring fetal heart rate tracing and prediction of adverse outcomes: interobserver variability

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.