- Email: [email protected]
657: Maternal characteristics and fetal outcomes for category I intrapartum fetal heart rate tracing
Poster Session IV
Academic Issues, etc
www.AJOG.org 656 Atypical variable decelerations: what features matter most? Emily Hamilton1, Colm Elliott2, Philip Warrick3 1
McGill University, Obstetrics and Gynecology, Montreal, Quebec, Canada, LMS Medical Systems, Montreal, Quebec, Canada, 3McGill University, Biomedical Engineering, Montreal, Quebec, Canada 2
OBJECTIVE: To compare the discriminating capacity of 7 different
CONCLUSION: The large majority of patients in term labor spend time
in both Cat I and Cat II FHR patterns. Cat III patterns are very uncommon. The frequency of Cat II FHR patterns increases significantly during the last two hours of labor. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.519
655 Category II fetal heart rate tracings (FHRTs) are associated with increased risk of operative delivery Torri Metz1, Tracy Manuck1, Calla Holmgren1, Erick Henry2, Kristina Milan1, Flint Porter1 1
University of Utah, Obstetrics and Gynecology, Salt Lake City, Utah, 2Intermountain Medical Center, Salt Lake City, Utah
OBJECTIVE: To determine if a category II FHRT is associated with an increased risk of operative delivery. STUDY DESIGN: Intrapartum electronic FHRTs from October 2008 for all term singletons were retrospectively evaluated from five regional hospitals. Time spent in NICHD category II during the last two hours of labor was determined based on archived nursing charting at 15-30 minute intervals. Maternal demographics and intrapartum data were collected. Scheduled cesareans were excluded. Statistical analysis included chi square, Fisher’s exact, Anova and logistical regression. RESULTS: 1,241 patients met inclusion criteria: 992(79.9%) spontaneous deliveries, 91(7.3%) operative vaginal deliveries, and 158(12.7%) cesareans. With the exception of BMI which was statistically higher among patients requiring cesareans, maternal characteristics did not vary among groups. Labor characteristics stratified by delivery mode are listed in Table 1. The percent of time in category II during the last two hours of labor was significantly associated with the need for operative delivery even when controlling for length of second stage. For every 10% increase in time spent in category II during the last two hours of labor, the odds of operative delivery increased 2.14 times (95% CI 1.17-3.90, p⫽0.014). CONCLUSION: Increased percentage of time with a category II FHRT during the last two hours of labor was associated with a significantly increased risk of operative delivery.
types of atypical variable decelerations (AtyV) in 3 study groups defined by degree of metabolic acidosis and neurological signs in the early neonatal period. STUDY DESIGN: We analyzed the last 5 hr of EFM from term pregnancies in an index group A - 62 babies with umbilical artery base deficit (BD) ⬎12 mmol/L and neonatal encephalopathy (NE) and in two convenience samples without NE; N - 3548 with normal gases and I 1855 with elevated base deficit (⬎8mmol/L). We compared ROC curves to find the most discriminating type of AtyV. RESULTS: AtyV were associated with adverse outcome. Not all atypical features were equal in terms of frequency and discriminating capacity. AtyV with any one of the following - loss of variability, 2 “Sixties” criteria or a biphasic shape - were the most discriminating (AUC 0.72). This combination was statistically better than any of the other 4 AtyV types which were not different from simple variable decelerations (P⬍0.001). Simple variable decelerations with no atypical features ranked lowest with the poorest AUC (0.52).
CONCLUSION: Most of the discriminating power associated with AtyV
resides in the top 3 types. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.521
657 Maternal characteristics and fetal outcomes for category I intrapartum fetal heart rate tracing Kristina Milan1, Tracy Manuck1, Erick Henry2, Sean Esplin3, Torri Metz4, Calla Holmgren1 1
University of Utah, Salt Lake City, Utah, 2Intermountain Health Care, Salt Lake City, Utah, 3Intermountain Healthcare, Salt Lake City, Utah, 4University of Utah, Utah
OBJECTIVE: To describe maternal characteristics and neonatal out-
Table 1. Labor characteristics stratified by delivery mode. P value < 0.05 was considered significant. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.520
S238
comes associated with NICHD category I fetal heart rate tracings (FHRTs) in term singletons. STUDY DESIGN: Intrapartum electronic FHRTs from October 2008 for all term singletons were retrospectively evaluated from five regional hospitals. Maternal demographics, intrapartum data, and neonatal outcomes were collected. Patients who had only category I FHRTs were compared to women who spent at least some time with a category II FHRT. All included had at least 1 hour of FHRT. Chi-square, student’s t-test, and logistic regression were used for analysis. RESULTS: 1300 women were included. 239 (18.4%) had a category I FHRT for the entire labor. Mean birth weight, marital status, insurance type, and substance abuse did not vary by with FHRT classification. Intrapartum characteristics are listed in table 1. In the multivariate logistic regression, increasing time in labor was associated with decreased odds of a category I FHRT for the entire labor. Amongst the neonates in category I for the entire labor, none had a pH⬍7.20 and 1
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2009
Academic Issues, etc
www.AJOG.org neonate (0.4%) had a 5-minute APGAR ⬍/⫽7. This neonate has suqsequently been diagnosed with a metabolic disorder. CONCLUSION: Women with category I only FHRTs are more likely to be older, multiparous, spontaneously laboring with shorter labors and less likely to receive parenteral narcotics and/or epidural. Category I tracings for the entirety of labor are associated with favorable neonatal outcomes.
Poster Session IV
659 Effect of opiate maintenance therapy on intrapartum fetal heart rate patterns Heather Alexander1, Mona Prasad1 1 The Ohio State University, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Columbus, Ohio
OBJECTIVE: To evaluate effects of opiate maintenence on intrapartum
FHR patterns. STUDY DESIGN: Case-control study comparing intrapartum FHR trac-
Intrapartum characteristics of women with category I FHRT for entire labor compared with women experiencing some category II during labor.
Multiparous (%)
Category I entire labor Nⴝ239
Some category II Nⴝ1061
P value
79.5
56.9
⬍0.001
..........................................................................................................................................................................................
Mean matl. age (y) 28.3 26.9 ⬍0.001 .......................................................................................................................................................................................... IV/IM narcotics (%) 13.8 19.2 0.050 .......................................................................................................................................................................................... Epidural (%) 80.8 92.8 ⬍0.001 .......................................................................................................................................................................................... Spontaneous (%) 38.9 27.9 0.001 .......................................................................................................................................................................................... Augmented (%) 8.8 27.6 ⬍0.001 .......................................................................................................................................................................................... 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.522
658 Outcome in cases with severe intrapartum acidemia diagnosed with fetal scalp blood sampling Malin Holzmann1, Sven Cnattingius2, Lennart Nordstrom1 1
Department of Obstet Gynecol, Karolinska Institute, Stockholm, Sweden, 2Department of Clinical Epidemiology, Karolinska Institute, Stockholm, Sweden
OBJECTIVE: To follow up cases with severe intrapartum acidemia diagnosed with fetal scalp blood sampling during labor with respect to short-term neonataloutcomes. STUDY DESIGN: In a randomised controlled trial, 2996 cases with fetal heart rate abnormalities indicating FBS were randomised to either scalp blood lactate or pH analyses (1). Median and 95th centile values in 2301 lactate analyses were 2.9 mmol/l and 6.6 mmol/l, respectively. Corresponding values from 1628 pH analyses were 7.30 (median) and 7.17 (5th centile). We defined severe intrapartum acidemia as lactate ⬎6.6 mmol/l or pH ⬍7.17. RESULTS: Severe intrapartum acidemia was present in 85/1355 (6.3%) cases where lactate analyses were available and in 69/1008 (6.8%) cases with pH analyses. Table 1 presents outcome data from these 154 cases. CONCLUSION: Severe neonatal morbidity was rare in this high risk group, when proper action was taken after FBS analyses. We conclude that FBS could be used to prevent birth acidemia. A tendency towards better outcome in the lactate analysis group was found, though significant only for NICU admissions. As lactate analysis has abolished sampling failure and has almost no false negative tests, we believe that it is a valuable tool in intrapartum fetal surveillance. Reference Wiberg-Itzel E et al. BMJ 2008;336:1284-7. Table 1 Scalp lactate >6.6 nⴝ85 (%)
Scalp pH <7.17 nⴝ69 (%)
Total nⴝ154 (%)
Cord artery pH ⬍7.00
2 (2.4)
3 (4.4)
5 (3.2)
Cord artery pH ⬍7.10
8 (9.4)
13 (18.8)
21 (13.6)
.......................................................................................................................................................................................... ..........................................................................................................................................................................................
Apgar ⬍7 @ 1 min 16 (18.8) 17 (24.6) 33 (21.4) .......................................................................................................................................................................................... Apgar ⬍7 @ 5 min 2 (2.4) 4 (5.8) 6 (3.9) .......................................................................................................................................................................................... NICU adm* 5 (5.9) 12 (17.4) 17 (11.0) .......................................................................................................................................................................................... HIE 2 (2.4) 2 (2.9) 4 (2.6) .......................................................................................................................................................................................... MAS 1 (1.2) 0 1 (0.6) .......................................................................................................................................................................................... 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.523
ings of women on methadone or buprenorphine to controls matched for age, parity, and gestational age. Inclusion criteria: age 18-44, singleton, & 36-41 weeks. Exclusion criteria: recent illicit drug/alcohol use, maternal medical or fetal conditions contributing to abnormal FHR patterns, or contraindications to vaginal delivery. Three blinded experts analyzed each FHR tracing during latent, active, and second stage of labor. Evaluation was based on an 8-point scoring system adapted by Ramirez-Cacho. Experts described baseline, variability, accelerations, and decelerations based on NICHD 2008 workshop guidelines. RESULTS: 20 methadone-exposed patients, 7 buprenorphine-exposed patients and 20 controls were reviewed. Baseline, variability, accelerations, recurrent variable or late decelerations were similar among the three groups. Latent phase scores were significantly lower in the methadone group compared to controls (7.588 vs 8.0, p⫽0.019). No differences in the mean scores between the three groups were found in the active or second stage. No differences in Apgars, rates of operative vaginal or cesarean deliveries, or presence of meconium were noted. NICU admissions were higher in the methadone group compared to the buprenorphine and control groups (56.25% vs. 14.29% vs. 0%, p⫽0.0003). Neonatal length of stay was greater in the methadoneexposed group (13 vs. 5.57 vs. 2.0 days p⬍0.0314). Infants born to mothers on methadone demonstrated lower birthweight (2968.5 gm) than the average birth weight in the buprenorphine (3333.6 gm, p⫽0.0017) and control groups (3381.75 gm, p⬍0.001). CONCLUSION: Significant differences in FHR scores during latent phase are demonstrated when comparing methadone exposed fetuses to controls. Although this did not correlate with significant differences in active phase, second stage, Apgars, mode of delivery or meconium, adverse neonatal outcomes associated with methadone maintenance are identified. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.524
660 Comparison of 5 experts and computer analysis in rulebased fetal heart rate (FHR) interpretation and management Julian T. Parer1, Emily F. Hamilton2 1
University of California, San Francisco, San Francisco, California, 2McGill University, Obstetrics & Gynecology, Montreal, Quebec, Canada
OBJECTIVE: To use a set of strictly defined rules regarding interpreta-
tion, and to compare the responses of 5 obstetrical clinicians to actual cases, and to further compare their evaluations to those of a computerized interpretation system given the same rules. STUDY DESIGN: Five expert obstetrical providers independently scored 30 cases, each of approximately 3 hrs, in 8 min segments, according to a 5-tier colour-coded framework, which contains guides to pattern description and proposals for management (Parer & Ikeda, AJOG 2007; 187:26). Computer analysis was with an FDA cleared device, CALM Patterns (TM) which detects baseline heart rate, variability, accelerations and decelerations (type, depth and duration). The quantitated findings were then combined according to the definitions in the 5 tier framework, where automated alerts could act as decision support tools. Various comparisons of the experts and the computer were made. RESULTS: Clinicians agreed exactly with the majority opinion in 57% (95% CI 46-67%) of the approximately 750 FHR segments, and were within 1 colour code in 87% (CI 80-96%). Kappa values averaged 0.58 (range 0.48-0.67), or moderate to substantial agreement. The computer scored midway within the clinicians’ range for these measures.
Supplement to DECEMBER 2009 American Journal of Obstetrics & Gynecology
S239
Academic Issues, etc
www.AJOG.org 656 Atypical variable decelerations: what features matter most? Emily Hamilton1, Colm Elliott2, Philip Warrick3 1
McGill University, Obstetrics and Gynecology, Montreal, Quebec, Canada, LMS Medical Systems, Montreal, Quebec, Canada, 3McGill University, Biomedical Engineering, Montreal, Quebec, Canada 2
OBJECTIVE: To compare the discriminating capacity of 7 different
CONCLUSION: The large majority of patients in term labor spend time
in both Cat I and Cat II FHR patterns. Cat III patterns are very uncommon. The frequency of Cat II FHR patterns increases significantly during the last two hours of labor. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.519
655 Category II fetal heart rate tracings (FHRTs) are associated with increased risk of operative delivery Torri Metz1, Tracy Manuck1, Calla Holmgren1, Erick Henry2, Kristina Milan1, Flint Porter1 1
University of Utah, Obstetrics and Gynecology, Salt Lake City, Utah, 2Intermountain Medical Center, Salt Lake City, Utah
OBJECTIVE: To determine if a category II FHRT is associated with an increased risk of operative delivery. STUDY DESIGN: Intrapartum electronic FHRTs from October 2008 for all term singletons were retrospectively evaluated from five regional hospitals. Time spent in NICHD category II during the last two hours of labor was determined based on archived nursing charting at 15-30 minute intervals. Maternal demographics and intrapartum data were collected. Scheduled cesareans were excluded. Statistical analysis included chi square, Fisher’s exact, Anova and logistical regression. RESULTS: 1,241 patients met inclusion criteria: 992(79.9%) spontaneous deliveries, 91(7.3%) operative vaginal deliveries, and 158(12.7%) cesareans. With the exception of BMI which was statistically higher among patients requiring cesareans, maternal characteristics did not vary among groups. Labor characteristics stratified by delivery mode are listed in Table 1. The percent of time in category II during the last two hours of labor was significantly associated with the need for operative delivery even when controlling for length of second stage. For every 10% increase in time spent in category II during the last two hours of labor, the odds of operative delivery increased 2.14 times (95% CI 1.17-3.90, p⫽0.014). CONCLUSION: Increased percentage of time with a category II FHRT during the last two hours of labor was associated with a significantly increased risk of operative delivery.
types of atypical variable decelerations (AtyV) in 3 study groups defined by degree of metabolic acidosis and neurological signs in the early neonatal period. STUDY DESIGN: We analyzed the last 5 hr of EFM from term pregnancies in an index group A - 62 babies with umbilical artery base deficit (BD) ⬎12 mmol/L and neonatal encephalopathy (NE) and in two convenience samples without NE; N - 3548 with normal gases and I 1855 with elevated base deficit (⬎8mmol/L). We compared ROC curves to find the most discriminating type of AtyV. RESULTS: AtyV were associated with adverse outcome. Not all atypical features were equal in terms of frequency and discriminating capacity. AtyV with any one of the following - loss of variability, 2 “Sixties” criteria or a biphasic shape - were the most discriminating (AUC 0.72). This combination was statistically better than any of the other 4 AtyV types which were not different from simple variable decelerations (P⬍0.001). Simple variable decelerations with no atypical features ranked lowest with the poorest AUC (0.52).
CONCLUSION: Most of the discriminating power associated with AtyV
resides in the top 3 types. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.521
657 Maternal characteristics and fetal outcomes for category I intrapartum fetal heart rate tracing Kristina Milan1, Tracy Manuck1, Erick Henry2, Sean Esplin3, Torri Metz4, Calla Holmgren1 1
University of Utah, Salt Lake City, Utah, 2Intermountain Health Care, Salt Lake City, Utah, 3Intermountain Healthcare, Salt Lake City, Utah, 4University of Utah, Utah
OBJECTIVE: To describe maternal characteristics and neonatal out-
Table 1. Labor characteristics stratified by delivery mode. P value < 0.05 was considered significant. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.520
S238
comes associated with NICHD category I fetal heart rate tracings (FHRTs) in term singletons. STUDY DESIGN: Intrapartum electronic FHRTs from October 2008 for all term singletons were retrospectively evaluated from five regional hospitals. Maternal demographics, intrapartum data, and neonatal outcomes were collected. Patients who had only category I FHRTs were compared to women who spent at least some time with a category II FHRT. All included had at least 1 hour of FHRT. Chi-square, student’s t-test, and logistic regression were used for analysis. RESULTS: 1300 women were included. 239 (18.4%) had a category I FHRT for the entire labor. Mean birth weight, marital status, insurance type, and substance abuse did not vary by with FHRT classification. Intrapartum characteristics are listed in table 1. In the multivariate logistic regression, increasing time in labor was associated with decreased odds of a category I FHRT for the entire labor. Amongst the neonates in category I for the entire labor, none had a pH⬍7.20 and 1
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2009
Academic Issues, etc
www.AJOG.org neonate (0.4%) had a 5-minute APGAR ⬍/⫽7. This neonate has suqsequently been diagnosed with a metabolic disorder. CONCLUSION: Women with category I only FHRTs are more likely to be older, multiparous, spontaneously laboring with shorter labors and less likely to receive parenteral narcotics and/or epidural. Category I tracings for the entirety of labor are associated with favorable neonatal outcomes.
Poster Session IV
659 Effect of opiate maintenance therapy on intrapartum fetal heart rate patterns Heather Alexander1, Mona Prasad1 1 The Ohio State University, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Columbus, Ohio
OBJECTIVE: To evaluate effects of opiate maintenence on intrapartum
FHR patterns. STUDY DESIGN: Case-control study comparing intrapartum FHR trac-
Intrapartum characteristics of women with category I FHRT for entire labor compared with women experiencing some category II during labor.
Multiparous (%)
Category I entire labor Nⴝ239
Some category II Nⴝ1061
P value
79.5
56.9
⬍0.001
..........................................................................................................................................................................................
Mean matl. age (y) 28.3 26.9 ⬍0.001 .......................................................................................................................................................................................... IV/IM narcotics (%) 13.8 19.2 0.050 .......................................................................................................................................................................................... Epidural (%) 80.8 92.8 ⬍0.001 .......................................................................................................................................................................................... Spontaneous (%) 38.9 27.9 0.001 .......................................................................................................................................................................................... Augmented (%) 8.8 27.6 ⬍0.001 .......................................................................................................................................................................................... 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.522
658 Outcome in cases with severe intrapartum acidemia diagnosed with fetal scalp blood sampling Malin Holzmann1, Sven Cnattingius2, Lennart Nordstrom1 1
Department of Obstet Gynecol, Karolinska Institute, Stockholm, Sweden, 2Department of Clinical Epidemiology, Karolinska Institute, Stockholm, Sweden
OBJECTIVE: To follow up cases with severe intrapartum acidemia diagnosed with fetal scalp blood sampling during labor with respect to short-term neonataloutcomes. STUDY DESIGN: In a randomised controlled trial, 2996 cases with fetal heart rate abnormalities indicating FBS were randomised to either scalp blood lactate or pH analyses (1). Median and 95th centile values in 2301 lactate analyses were 2.9 mmol/l and 6.6 mmol/l, respectively. Corresponding values from 1628 pH analyses were 7.30 (median) and 7.17 (5th centile). We defined severe intrapartum acidemia as lactate ⬎6.6 mmol/l or pH ⬍7.17. RESULTS: Severe intrapartum acidemia was present in 85/1355 (6.3%) cases where lactate analyses were available and in 69/1008 (6.8%) cases with pH analyses. Table 1 presents outcome data from these 154 cases. CONCLUSION: Severe neonatal morbidity was rare in this high risk group, when proper action was taken after FBS analyses. We conclude that FBS could be used to prevent birth acidemia. A tendency towards better outcome in the lactate analysis group was found, though significant only for NICU admissions. As lactate analysis has abolished sampling failure and has almost no false negative tests, we believe that it is a valuable tool in intrapartum fetal surveillance. Reference Wiberg-Itzel E et al. BMJ 2008;336:1284-7. Table 1 Scalp lactate >6.6 nⴝ85 (%)
Scalp pH <7.17 nⴝ69 (%)
Total nⴝ154 (%)
Cord artery pH ⬍7.00
2 (2.4)
3 (4.4)
5 (3.2)
Cord artery pH ⬍7.10
8 (9.4)
13 (18.8)
21 (13.6)
.......................................................................................................................................................................................... ..........................................................................................................................................................................................
Apgar ⬍7 @ 1 min 16 (18.8) 17 (24.6) 33 (21.4) .......................................................................................................................................................................................... Apgar ⬍7 @ 5 min 2 (2.4) 4 (5.8) 6 (3.9) .......................................................................................................................................................................................... NICU adm* 5 (5.9) 12 (17.4) 17 (11.0) .......................................................................................................................................................................................... HIE 2 (2.4) 2 (2.9) 4 (2.6) .......................................................................................................................................................................................... MAS 1 (1.2) 0 1 (0.6) .......................................................................................................................................................................................... 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.523
ings of women on methadone or buprenorphine to controls matched for age, parity, and gestational age. Inclusion criteria: age 18-44, singleton, & 36-41 weeks. Exclusion criteria: recent illicit drug/alcohol use, maternal medical or fetal conditions contributing to abnormal FHR patterns, or contraindications to vaginal delivery. Three blinded experts analyzed each FHR tracing during latent, active, and second stage of labor. Evaluation was based on an 8-point scoring system adapted by Ramirez-Cacho. Experts described baseline, variability, accelerations, and decelerations based on NICHD 2008 workshop guidelines. RESULTS: 20 methadone-exposed patients, 7 buprenorphine-exposed patients and 20 controls were reviewed. Baseline, variability, accelerations, recurrent variable or late decelerations were similar among the three groups. Latent phase scores were significantly lower in the methadone group compared to controls (7.588 vs 8.0, p⫽0.019). No differences in the mean scores between the three groups were found in the active or second stage. No differences in Apgars, rates of operative vaginal or cesarean deliveries, or presence of meconium were noted. NICU admissions were higher in the methadone group compared to the buprenorphine and control groups (56.25% vs. 14.29% vs. 0%, p⫽0.0003). Neonatal length of stay was greater in the methadoneexposed group (13 vs. 5.57 vs. 2.0 days p⬍0.0314). Infants born to mothers on methadone demonstrated lower birthweight (2968.5 gm) than the average birth weight in the buprenorphine (3333.6 gm, p⫽0.0017) and control groups (3381.75 gm, p⬍0.001). CONCLUSION: Significant differences in FHR scores during latent phase are demonstrated when comparing methadone exposed fetuses to controls. Although this did not correlate with significant differences in active phase, second stage, Apgars, mode of delivery or meconium, adverse neonatal outcomes associated with methadone maintenance are identified. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.524
660 Comparison of 5 experts and computer analysis in rulebased fetal heart rate (FHR) interpretation and management Julian T. Parer1, Emily F. Hamilton2 1
University of California, San Francisco, San Francisco, California, 2McGill University, Obstetrics & Gynecology, Montreal, Quebec, Canada
OBJECTIVE: To use a set of strictly defined rules regarding interpreta-
tion, and to compare the responses of 5 obstetrical clinicians to actual cases, and to further compare their evaluations to those of a computerized interpretation system given the same rules. STUDY DESIGN: Five expert obstetrical providers independently scored 30 cases, each of approximately 3 hrs, in 8 min segments, according to a 5-tier colour-coded framework, which contains guides to pattern description and proposals for management (Parer & Ikeda, AJOG 2007; 187:26). Computer analysis was with an FDA cleared device, CALM Patterns (TM) which detects baseline heart rate, variability, accelerations and decelerations (type, depth and duration). The quantitated findings were then combined according to the definitions in the 5 tier framework, where automated alerts could act as decision support tools. Various comparisons of the experts and the computer were made. RESULTS: Clinicians agreed exactly with the majority opinion in 57% (95% CI 46-67%) of the approximately 750 FHR segments, and were within 1 colour code in 87% (CI 80-96%). Kappa values averaged 0.58 (range 0.48-0.67), or moderate to substantial agreement. The computer scored midway within the clinicians’ range for these measures.
Supplement to DECEMBER 2009 American Journal of Obstetrics & Gynecology
S239