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The impact that intense ‘fetal-physiology’ training has on inter-observer agreement in interpreting intrapartum cardiotocograph traces in comparison to the classical ‘pattern-recognition’ approach: a prospective observational study
  • Juan de Dios Gutierrez Henares,
  • David Diaz Gomez,
  • Edwin Chandraharan
Juan de Dios Gutierrez Henares
St George's University Hospitals NHS Foundation Trust

Corresponding Author:juandedue@gmail.com

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David Diaz Gomez
St George's University Hospitals NHS Foundation Trust
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Edwin Chandraharan
Tianjin Central Hospital of Obstetrics and Gynecology
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Abstract Objective: To explore the level of agreement as well as the contribution of human-factors on CTG interpretation in a hospital where a high intense, ‘fetal physiology-based’ training on CTG-interpretation was implemented by a dedicated CTG-Team. Design: Prospective observational study Setting: Tertiary Hospital, UK Population: A total of 25 midwives and 7 doctors (≈10% of staff) Method: interpretation of 5 anonymised colour-printed copies of 5 different CTGs using a questionnaire (160 CTG interpretations) using local CTG-guidelines (pattern-recognition approach) and Types of hypoxia (fetal-physiology). Results: Interpretation of CTG by type of hypoxia compared against CTG-guidelines presented better Proportion of concordance (PC=76.1% vs 61.2%, P=0.006) and slightly better reliability (K= 0.37 (0.35–0.39) vs 0.33 (0.32–0.36)). Doctors rely most in fetal-physiology than midwives who rely most in guidelines. Overall, 68% of the staff felt confident or very confident in CTG interpretation. In general, Self-reported confidence on CTG interpretation and fetal-physiology knowledge increased with the level of seniority. Conclusions: ‘Fetal-physiology-based’ training increases level of self-reported confidence and level of fetal-physiology knowledge leading to better inter-observer agreement and reliability in CTG interpretation especially when considering type of hypoxia in CTG-classification. Funding: JG collected the data as part of a Self-funded university MSc program. A secondary analysis of the data was performed to elaborate this manuscript. There is no source of funding to declare by the rest of co-authors in this paper. Keywords: Fetal-physiology, Cardiotocography Interpretation, Intrapartum fetal monitoring, Inter-observer agreement,