Interobserver agreement among midwives in cardiotocography interpretation using the 2015 FIGO guidelines for intrapartum fetal monitoring: A retrospective study

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OBJECTIVE: To evaluate the interobserver agreement among midwives for the classification of intrapartum cardiotocography (CTG) tracings and their main parameters-that is, fetal heart rate baseline, variability and decelerations-according to the 2015 FIGO guidelines. METHODS: This was a retrospective, single center observational study conducted at the Maternity Hospital of the University of Parma, Italy between January and September 2024. We selected 100 non-consecutive intrapartum CTG tracings before operative delivery. A total of six participating midwives (3 senior and 3 junior) received the last 60 min of CTG recordings and classified the trace at the moment of the decision for the operative delivery. The main outcome was the interobserver agreement of the overall interpretation of the CTG tracings. Secondary outcomes included the interobserver agreement for each individual CTG parameter. The agreement between the observers was estimated through the Fleiss' kappa (κ). RESULTS: The overall interobserver agreement for CTG interpretation was fair (κ = 0.35, 95% confidence interval [CI]: 0.31-0.38). The highest agreement was observed for the normal category (κ = 0.50, 95% CI: 0.45-0.55), while suspicious and pathologic classifications showed lower agreement (κ = 0.25, 95% CI: 0.20-0.30 and 0.37, 95% CI: 0.32-0.42, respectively). Among CTG parameters, decelerations achieved the highest agreement (κ = 0.48, 95% CI: 0.43-0.53), followed by baseline rate (κ = 0.43, 95% CI: 0.39-0.47). In contrast, agreement on variability was poor (κ = 0.20, 95% CI: 0.16-0.24). CONCLUSION: The overall interobserver agreement for intrapartum CTG interpretation using the 2015 FIGO guidelines was fair. Agreement for individual parameters varied widely.

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