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
Abstract
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,