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Inter-observer variation in assessment of 845 labour admission tests: comparison between midwives and obstetricians in the clinical setting and two experts.
Nordic Council of Ministers, Nordic School of Public Health NHV.
2003 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 110, no 1, 1-5 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To assess the inter-observer agreement in assessment of the labour admission test between midwives and obstetricians in the clinical setting and two experts in the non-clinical setting, the inter-observer agreement between two experts in the non-clinical setting and to what degree fetal distress in labour could be predicted by the two experts.

DESIGN: Observational study.

SETTING: The maternity unit of Hammerfest Hospital, Norway.

POPULATION: Eight hundred and forty-five high and low risk women.

METHOD: The labour admission test was first assessed by the midwife or obstetrician in the clinical setting, and was later assessed by two experts. The traces were assessed as normal, equivocal or ominous. Weighted kappa (kappaw), proportion of agreement (Pa) and predictive values were calculated.

MAIN OUTCOME MEASURES: Weighted kappa, proportion of agreement, sensitivity, positive predictive value and likelihood ratios.

RESULTS: Inter-observer agreement between Expert 1 and Expert 2: kappaw 0.38 (CI 0.31-0.46), Pa for reactive labour admission test 0.86 (CI 0.83-0.88) and Pa for equivocal/ominous test 0.33 (CI 0.26-0.40). Agreement between Expert 1 and midwives/obstetricians: kappaw 0.25 (CI 0.15-0.36), Pa for reactive labour admission test 0.89 (CI 0.87-0.91) and Pa for equivocal/ominous labour admission test 0.18 (CI 0.11-0.25). Agreement between Expert 2 and midwives/obstetricians: kappaw 0.28 (CI 0.20-0.37), Pa for reactive labour admission test 0.85 (CI 0.82-0.88) and Pa for equivocal/ominous test 0.20 (CI 0.14-0.26). Totally 5.9% of the newborns had fetal distress. At cutoff equivocal test, sensitivity was 0.22 and 0.31 in the two observers. Positive predictive values were 0.13 and 0.11. Likelihood ratio for a positive test was 2.30 and 1.92 and likelihood ratio for a negative test 0.86 and 0.83.

CONCLUSION: A labour admission test is still routine practice in most obstetric units in the Western world when there is little evidence on its benefits. The results from this study may provide some reconsideration for such practice, and for more research.

Place, publisher, year, edition, pages
2003. Vol. 110, no 1, 1-5 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3389PubMedID: 12504927OAI: oai:DiVA.org:norden-3389DiVA: diva2:747911
Available from: 2014-09-17 Created: 2014-09-17 Last updated: 2014-10-15Bibliographically approved
In thesis
1. INNKOMST-CTG. En vurdering av testens prediktive verdier, reliabilitet og effekt: Betydning for jordmødre i deres daglige arbeid
Open this publication in new window or tab >>INNKOMST-CTG. En vurdering av testens prediktive verdier, reliabilitet og effekt: Betydning for jordmødre i deres daglige arbeid
2006 (Norwegian)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Göteborg: Nordic School of Public Health NHV Göteborg, Sweden, 2006. 93 p.
Series
NHV Reports and Doctor of Public Health-Theses, ISSN 0283-1961 ; Report 2006:3
Keyword
Cardiotocography, Labour, Admission Test, Screening, Inter-Observer Agreement, Systematic review, Midwifery Practice, Kardiotokografi, Inkomst-CTG, Screening, Prediktive Verdier, Inter-Observatør Enighet, Kappa, Jordemorpraksis
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3393 (URN)91-7997-149-0 (ISBN)
Public defence
2006-12-19, Nordic School of Public Health NHV, Göteborg, Sweden, 13:00 (Norwegian)
Opponent
Supervisors
Available from: 2014-09-18 Created: 2014-09-18 Last updated: 2014-09-18Bibliographically approved

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