Interobserver agreement in CTG classification and clinical decision during labour: a comparison between STAN2007 and STAN2022 classifications

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY Journal of gynecology obstetrics and human reproduction Pub Date : 2024-11-07 DOI:10.1016/j.jogoh.2024.102874

Delphine Duchanois , Lola Loussert , Anais Provendier , Carole Brouet , Maeva Chavin , Louise Paret , Paul Guerby , Virginie Ehlinger , Christophe Vayssière

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Abstract

ST analysis during labour requires the classification of CTG traces in order to help clinical decisions. The usual STAN classification is based on the FIGO 1987 classification, modified in 2007. New STAN guidelines adapted to physiology-based interpretation have been proposed in 2022. This study compares the interobserver agreement of CTG classification and clinical decisions making, and the ease of use following the 2022 and 2007 STAN guidelines.

Material and Methods

Thirty CTG traces from STAN monitors were selected from a local French database and analysed (CTG classification, clinical decision making) by six observers with different levels of experience in two sessions three months apart. Observers followed the STAN2007 and the STAN2022 guidelines in the first and in the second sessions respectively. Weighted kappa (primary outcome), proportion of complete agreement within the 6 observers, and percent agreement (secondary outcomes) were estimated. At the end of the second session observers rated their satisfaction, ease of use and which guidelines they preferred.

Results

The interobserver agreement for CTG classification were comparable when following STAN2007 and STAN2022 guidelines (weighted kappa 0.57 versus 0.58, P = 0.91, moderate agreement), but a higher proportion of complete agreement within the 6 observers and a higher percent agreement were obtained when following STAN2022 compared to STAN2007 guidelines (complete agreement 50 % versus 20 % respectively, P = 0.01; percentage of agreement 72 % vs 55 %, P = 0.006). Interobserver agreement for clinical decisions did not differ when following STAN2007 or STAN2022 guidelines. Satisfaction scores were higher with STAN2022 guidelines, but not significantly (P = 0.052). All 6 observers stated that they preferred to use the STAN2022 guidelines.

Conclusion

Interobserver agreement is comparable between STAN2022 and STAN2007 for CTG classification in labour and clinical decision making. However, complete agreement and percent agreement are in favour of STAN 2022 for CTG classification.

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分娩过程中 CTG 分类和临床决策的观察者间一致性：STAN2007 和 STAN2022 分类的比较。

分娩过程中的 ST 分析需要对 CTG 曲线进行分类，以帮助临床决策。通常的 STAN 分类以 FIGO 1987 年的分类为基础，并于 2007 年进行了修改。2022 年提出了新的 STAN 指南，以适应基于生理学的解释。本研究比较了 CTG 分类和临床决策的观察者间一致性，以及 2022 年和 2007 年 STAN 指南的易用性：从法国当地的数据库中选取了 30 个 STAN 监护仪的 CTG 曲线，由六名具有不同经验水平的观察者进行分析（CTG 分类、临床决策），两次分析相隔三个月。观察者在第一次和第二次会议中分别遵循 STAN2007 和 STAN2022 指南。对加权卡帕（主要结果）、6 名观察员完全一致的比例和一致百分比（次要结果）进行了估算。在第二个环节结束时，观察员对其满意度、易用性和他们更喜欢的指南进行评分：根据 STAN2007 和 STAN2022 指南进行 CTG 分类时，观察者之间的一致性相当（加权卡帕为 0.57 对 0.58，P=0.91，中度一致），但与 STAN2007 指南相比，根据 STAN2022 指南进行 CTG 分类时，6 名观察者之间的完全一致比例更高，一致百分比更高（完全一致比例分别为 50%对 20%，P=0.01；一致百分比为 72% 对 55%，P=0.006）。在遵循 STAN2007 或 STAN2022 指南时，临床决策的观察者间一致性没有差异。STAN2022指南的满意度评分更高，但并不显著（P=0.052）。所有 6 位观察员都表示他们更愿意使用 STAN2022 指南：结论：在分娩 CTG 分类和临床决策方面，STAN2022 和 STAN2007 的观察者间一致性相当。然而，在 CTG 分类方面，STAN2022 的完全一致率和一致率更高。

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来源期刊

Journal of gynecology obstetrics and human reproduction Medicine-Obstetrics and Gynecology

CiteScore

3.70

自引率

5.30%

发文量

210

审稿时长

31 days

期刊介绍： Formerly known as Journal de Gynécologie Obstétrique et Biologie de la Reproduction, Journal of Gynecology Obstetrics and Human Reproduction is the official Academic publication of the French College of Obstetricians and Gynecologists (Collège National des Gynécologues et Obstétriciens Français / CNGOF). J Gynecol Obstet Hum Reprod publishes monthly, in English, research papers and techniques in the fields of Gynecology, Obstetrics, Neonatology and Human Reproduction: (guest) editorials, original articles, reviews, updates, technical notes, case reports, letters to the editor and guidelines. Original works include clinical or laboratory investigations and clinical or equipment reports. Reviews include narrative reviews, systematic reviews and meta-analyses.