Document Detail

Intrapartum nonreassuring fetal heart rate tracing and prediction of adverse outcomes: interobserver variability.
MedLine Citation:
PMID:  18667185     Owner:  NLM     Status:  MEDLINE    
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.
Suneet P Chauhan; Chad K Klauser; Thomas C Woodring; Maureen Sanderson; Everett F Magann; John C Morrison
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Publication Detail:
Type:  Journal Article     Date:  2008-07-30
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  199     ISSN:  1097-6868     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-12-16     Completed Date:  2009-01-22     Revised Date:  2009-06-01    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  623.e1-5     Citation Subset:  AIM; IM    
Department of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Aurora Health Care, West Allis, WI, USA.
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MeSH Terms
Apgar Score
Cesarean Section / methods*
Cohort Studies
Emergency Treatment / methods
Fetal Distress / diagnosis*
Fetal Monitoring / methods*
Heart Rate, Fetal / physiology*
Hydrogen-Ion Concentration
Infant, Newborn
Labor Stage, Second
Labor, Obstetric
Observer Variation
Predictive Value of Tests
Pregnancy Outcome*
Risk Assessment
Sensitivity and Specificity
Time Factors
Trial of Labor
Young Adult
Comment In:
Am J Obstet Gynecol. 2009 Jun;200(6):e8   [PMID:  19286149 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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