Cardiotocography in labor: an exploratory analysis of fetal heart rate (FHR) interpretative uniformity in Alto Adige

Cardiotocography (CTG) is a screening tool to monitor fetal well-being during labor and delivery. The overall process of interpreting CTG during labor is known to be subject to significant inter-observer and intra-observer variability and the need to reduce this variability of interpretation has not only a clinical and care role but is of considerable importance for medical-legal reasons. We have reported an exploratory analysis of the interpretational variation of the same FHR-tracing recorded during labor by different clinical figures.
Materials and Methods. The aim of this study was to evaluate the uniformity of interpretation of a CTG-tracing in labor performed by medical and obstetrical personnel in a single Italian health-district (Alto Adige).
Results. 40 health-care professionals responded to the questionnaire, 11 of whom were physicians specialized in gynecology (27.5%) and 29 were in the profession of midwifery (72.5%).
There was a non-coincidence among all participants in terms of prioritization of potential cardiotocographic indices of fetal non-wellness.  Our study confirmed that the interpretation of the CTG pattern is highly subjective, irrespective of the guideline adopted, and CTG-misinterpretation represents the major determinant for increased frequency of obstetrical intervention during labor.
Conclusions. A difference in the interpretation of CTG-tracks exists, has been described in the literature and highlighted by our study. Advanced continuous training on the interpretation of CTG in labor, cases audit and debriefing, involving all the team, is certainly the best method to implement the knowledge of fetal heart rate tracing interpretation and to standardize the labor and delivery management.

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