Reliability and agreement in interpreting intrapartum foetal heart rate
monitoring: a systematic review and meta-analysis
Abstract
Background Intrapartum foetal heart rate (FHR) monitoring helps assess
foetal wellbeing. It relies on observers’ subjective assessments, with
variation in interpretations leading to variations in intrapartum care.
Objectives To summarize and evaluate inter- and intra-rater reliability
research on human interpretation of intrapartum FHR monitoring. Search
Strategy We searched for the terms ‘foetal heart rate monitoring’,
‘interpretation agreement’ and related concepts on Embase, Medline,
Maternity & Infant Care Database and CINAHL. Last search was 31st
January 2022. Selection Criteria We included studies that assess inter-
and intra-rater reliability of health professionals’ intrapartum FHR
monitoring and excluded studies including other assessment of foetal
wellbeing. Data collection and analysis We extracted data in reviewer
pairs using QAREL (quality appraisal tool for studies of diagnostic
reliability) forms. We performed a random effect meta-analysis to
present pooled estimates with 95% confidence intervals. Narrative
synthesis reported results not appropriate for meta-analysis. Main
results Forty-nine articles concerning continuous FHR monitoring were
included, all with considerable heterogeneity in quality and measures.
The pooled κ coefficient was 0.45 (95% CI 0.33-0.56) for FIGO
(International Federation of Gynecology and Obstetrics) classifications.
Conclusions There are few high-quality studies that evaluate inter- and
intra-observer variations in intrapartum FHR monitoring. We found great
variation in reliability measures and noted methodological concerns in
the studies. Funding C. H. Engelhart received a PhD scholarship from the
Norwegian Research Centre for Women’s Health at Oslo University
Hospital. Keywords Inter-rater reliability and agreement, intra-rater
reliability and agreement, foetal heart rate monitoring, systematic
review, meta-analysis.