Intrapartum fetal heart rate tracings: accuracy of interpretation is unaffected by level of providers’ training

Abstract

Objective: The ACOG Technical Bulletin of July 1995 suggests that intrapartum fetal heart rate patterns should be interpreted as reassuring or nonreassuring. The bulletin describes a nonreassuring fetal heart tracing (FHT) as having one or more of the following components: abnormal baseline (ie, tachycardia, decreased variability); the presence of variable decelerations that are persistent, progressively deeper and longer lasting; late decelerations that are persistent; prolonged deceleration greater than 60 seconds; and a sinusoidal heart rate pattern. A reassuring FHT implies the absence of these patterns. We sought to investigate the accuracy of interobserver interpretation of FHT in labor. Method: Three hundred sixty intrapartum FHTs were evaluated by obstetric residents, attendings, nurses, and maternal–fetal medicine specialists (MFMs). Tracings were accompanied by a questionnaire addressing classification of FHT, a proposed approach, and anticipated fetal outcome. Participants were blinded to actual outcomes. Results: 1) Of reassuring FHTs, 96% were identified with no significant difference in rate of identification in each provider group; 2) 80% of nonreassuring patterns were identified with similar rates of identification within each provider group; and 3) there was no significant interobserver difference in the correct interpretation of tracings between residents (75.5%), attendings (81.9%), MFMs (77.4%), and nurses (85%). Conclusion: Our data suggest that theTechnical Bulletin’s recommended classification of intrapartum FHT tracings as reassuring versus nonreassuring is successful in providing a simple, accurate method of recognition regardless of the providers’ level of obstetric training.