Interobserver and Intraobserver Agreement of Antenatal Cardiotocography
Assessments by Maternity Care Professionals: A Prospective Study.
Objective In the Netherlands, antenatal cardiotocography (aCTG)
is performed in obstetrician-led care to assess fetal well-being. An
innovation project was initiated to evaluate whether aCTG is feasible in
non-obstetrician-led care settings. Healthy women received aCTG in
midwife-led care if indicated for specific indications. Quality
assessment is essential when shifting tasks and responsibilities.
Therefore, we aimed to assess the interobserver and intraobserver
agreement for aCTG assessments among four professional groups regarding
the overall classification and the assessment of the various components
of the CTG. Design Prospective study. Sample 47 Dutch
primary care midwives, hospital-based midwives, residents, and
obstetricians. Methods Ten aCTG traces were assessed twice at a
one month interval on baseline heart frequency, accelerations,
decelerations, variability and contractions, and overall classification.
We used two sets of ten aCTG traces to ensure sufficient variation.
Main Outcome Measure Proportion of agreement. Results
The proportions of agreement for interobserver agreement on
classification of aCTG among the professional groups varied from 0.82 to
0.94, indicating excellent agreement. The proportions of agreement for
primary care midwives, hospital-based midwives and obstetricians were
slightly higher for intraobserver (0.86 to 0.94) than for interobserver
agreement. For various CTG components, the proportions of agreement for
interobserver agreement varied from 0.64 (presence of contractions) to
0.98 (baseline heart frequency), indicating good to excellent agreement.
Conclusion Excellent agreement for the overall classification
and good to excellent agreement for the various components were found in
the assessments of aCTG in healthy women, both between and within the
different professional groups.