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Reliability and agreement in interpreting intrapartum foetal heart rate monitoring: a systematic review and meta-analysis
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  • Christina Engelhart,
  • Kjetil Gundro Brurberg,
  • Kristin Jerve Aanstad,
  • Aase Pay,
  • Anne Kaasen,
  • Ellen Blix,
  • Sophie Vanbelle
Christina Engelhart
Oslo University Hospital

Corresponding Author:cheng@oslomet.no

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Kjetil Gundro Brurberg
Norwegian Institute of Public Health
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Kristin Jerve Aanstad
Oslo Metropolitan University Faculty of Health Sciences
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Aase Pay
Vestre Viken Hospital Trust
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Anne Kaasen
Oslo Metropolitan University
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Ellen Blix
Oslo Metropolitan University Faculty of Health Sciences
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Sophie Vanbelle
Maastricht University
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Background Intrapartum foetal heart rate (FHR) monitoring helps assess foetal wellbeing. It relies on observers’ subjective assessments, with variation in interpretations leading to variations in intrapartum care. Objectives To summarize and evaluate inter- and intra-rater reliability research on human interpretation of intrapartum FHR monitoring. Search Strategy We searched for the terms ‘foetal heart rate monitoring’, ‘interpretation agreement’ and related concepts on Embase, Medline, Maternity & Infant Care Database and CINAHL. Last search was 31st January 2022. Selection Criteria We included studies that assess inter- and intra-rater reliability of health professionals’ intrapartum FHR monitoring and excluded studies including other assessment of foetal wellbeing. Data collection and analysis We extracted data in reviewer pairs using QAREL (quality appraisal tool for studies of diagnostic reliability) forms. We performed a random effect meta-analysis to present pooled estimates with 95% confidence intervals. Narrative synthesis reported results not appropriate for meta-analysis. Main results Forty-nine articles concerning continuous FHR monitoring were included, all with considerable heterogeneity in quality and measures. The pooled κ coefficient was 0.45 (95% CI 0.33-0.56) for FIGO (International Federation of Gynecology and Obstetrics) classifications. Conclusions There are few high-quality studies that evaluate inter- and intra-observer variations in intrapartum FHR monitoring. We found great variation in reliability measures and noted methodological concerns in the studies. Funding C. H. Engelhart received a PhD scholarship from the Norwegian Research Centre for Women’s Health at Oslo University Hospital. Keywords Inter-rater reliability and agreement, intra-rater reliability and agreement, foetal heart rate monitoring, systematic review, meta-analysis.