Accuracy of fetal heart-rate variability interpretation by obstetricians using the criteria of the National Institute of Child Health and Human Development compared with computer-aided interpretation

Abstract

Aim: To evaluate the accuracy of fetal heart rate variability interpretation by obstetricians using the criteria of the National Institute of Child Health and Human Development (NICHD), compared with computer-aided analysis as a gold standard. Methods: One hundred and fourteen panels of fetal heart-rate tracings derived from electrocardiogram via scalp electrodes obtained from women with high-risk pregnancies during the intrapartum period. The tracings were interpreted using computer analysis and recorded as a gold standard. The same tracings were distributed to six observers: three residents in the third year of training and three faculty members. All observers blindly interpreted the fetal heart-rate variability without the knowledge of the computer analysis. The main outcome measures were; (i) the accuracy of fetal heart-rate variability interpretation by obstetricians using the NICHD criteria compared with computer-aided analysis was presented as a percentage value; and (ii) the agreement of fetal heart-rate variability interpretation between the obstetricians and the computer analysis using the NICHD criteria was presented as a κ-value. Result: When using the computer analysis as a gold standard, the accuracy of fetal heart-rate variability interpretation in the residents group was 81.58%, 86,84% and 82.46%, respectively, with a mean of 83.62%, whereas the accuracy of the faculty members was 79.82%, 67.54% and 79.82%, respectively, with a mean of 75.73%. κ-values, representing the agreement of interpretation, were 0.70, 0.78 and 0.72, with a mean of 0.73 ±0.04 among the residents, and 0.67, 0.50 and 0.68, with a mean of 0.62 ± 0.10 among the faculty members. Agreements in the two groups were not significantly different (Student's t-test, P = 0.14). Conclusion: Using the NICHD criteria, the accuracy and agreement of fetal heart-rate variability interpretation in the third-year residents and faculty members are substantial. There was no difference between the groups with regard to the agreement of fetal heart-rate variability interpretation.