Beschreibung:
<jats:title>Abstract</jats:title><jats:sec><jats:title>Rationale, aims and objectives</jats:title><jats:p>To evaluate obstetricians' inter‐ and intra‐observer agreement on intrapartum cardiotocogram (<jats:styled-content style="fixed-case">CTG</jats:styled-content>) recordings and to examine obstetricians' evaluations with respect to umbilical artery <jats:styled-content style="fixed-case">pH</jats:styled-content> and base deficit.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Nine experienced obstetricians annotated 634 intrapartum <jats:styled-content style="fixed-case">CTG</jats:styled-content> recordings. The evaluation of each recording was divided into four steps: evaluation of two 30‐minute windows in the first stage of labour, evaluation of one window in the second stage of labour and labour outcome prediction. The complete set of evaluations used for this experiment is available online. The inter‐ and intra‐observer agreement was evaluated using proportion of agreement and kappa coefficient. Clinicians' sensitivity and specificity was computed with respect to umbilical artery <jats:styled-content style="fixed-case">pH</jats:styled-content>, base deficit and to <jats:styled-content style="fixed-case">A</jats:styled-content>pgar score at the fifth minute.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The overall proportion of agreement between clinicians reached 48% with 95% confidence intervals (<jats:styled-content style="fixed-case">CI</jats:styled-content>) (<jats:styled-content style="fixed-case">CI</jats:styled-content>: 47–50). Regarding the different classes, proportion of agreement ranged from 57% (<jats:styled-content style="fixed-case">CI</jats:styled-content>: 54–60) for normal to 41% (<jats:styled-content style="fixed-case">CI</jats:styled-content>: 36–46) for pathological class. The sensitivity of clinicians' majority vote to objective outcome was 39% (<jats:styled-content style="fixed-case">CI</jats:styled-content>: 16–63) for the umbilical artery base deficit and 27% (<jats:styled-content style="fixed-case">CI</jats:styled-content>: 16–42) for <jats:styled-content style="fixed-case">pH</jats:styled-content>. The specificity was 89% (<jats:styled-content style="fixed-case">CI</jats:styled-content>: 86–92) for both types of objective outcome.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The reported inter‐/intra‐observer variability is large and this holds irrespective of clinicians' experience or work place. The results support the need of modernized guidelines for <jats:styled-content style="fixed-case">CTG</jats:styled-content> evaluation and/or objectivization and repeatability by introduction of a computerized approach that could standardize the process of <jats:styled-content style="fixed-case">CTG</jats:styled-content> evaluation within the delivery ward.</jats:p></jats:sec>