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Intra- and interobserver agreement among obstetric experts in court regarding the review of abnormal fetal heart rate tracings and obstetrical management

  • Laura Sabiani
    Correspondence
    Corresponding author: Laura Sabiani, MD.
    Affiliations
    Faculté de Médecine de Marseille, Aix-Marseile Université, Marseille, France

    Service de Gynécologie Obstétrique, Assistance Publique des Hôpitaux de Marseille, Hôpital de la Conception, Marseille, France
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  • Renaud Le Dû
    Affiliations
    Faculté de Médecine de Marseille, Aix-Marseile Université, Marseille, France
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  • Anderson Loundou
    Affiliations
    Faculté de Médecine de Marseille, Aix-Marseile Université, Marseille, France

    Unité d’Aide Méthodologique à la Recherche Clinique, Assistance Publique des Hôpitaux de Marseille, Marseille, France

    Laboratoire de Santé Publique, Faculté de Médecine, Marseille, France
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  • Claude d’Ercole
    Affiliations
    Faculté de Médecine de Marseille, Aix-Marseile Université, Marseille, France

    Service de Gynécologie Obstétrique, Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Marseille, France
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  • Florence Bretelle
    Affiliations
    Faculté de Médecine de Marseille, Aix-Marseile Université, Marseille, France

    Service de Gynécologie Obstétrique, Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Marseille, France
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  • Léon Boubli
    Affiliations
    Faculté de Médecine de Marseille, Aix-Marseile Université, Marseille, France

    Service de Gynécologie Obstétrique, Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Marseille, France
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  • Xavier Carcopino
    Affiliations
    Faculté de Médecine de Marseille, Aix-Marseile Université, Marseille, France

    Service de Gynécologie Obstétrique, Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Marseille, France

    IMBE, Aix Marseille Université, Centre National de la Recherche Scientifique, IRD, Université Avignon, Avignon, France
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Published:September 05, 2015DOI:https://doi.org/10.1016/j.ajog.2015.08.066

      Objective

      The objective of the study was to evaluate the intra- and interobserver agreement among obstetric experts in court regarding the retrospective review of abnormal fetal heart rate tracings and obstetrical management of patients with abnormal fetal heart rate during labor.

      Study Design

      A total of 22 French obstetric experts in court reviewed 30 cases of term deliveries of singleton pregnancies diagnosed with at least 1 hour of abnormal fetal heart rate, including 10 cases with adverse neonatal outcome. The experts reviewed all cases twice within a 3-month interval, with the first review being blinded to neonatal outcome. For each case reviewed, the experts were provided with the obstetric data and copies of the complete fetal heart rate recording and the partogram. The experts were asked to classify the abnormal fetal heart rate tracing and to express whether they agreed with the obstetrical management performed. When they disagreed, the experts were asked whether they concluded that an error had been made and whether they considered the obstetrical management as the cause of cerebral palsy in children if any.

      Results

      Compared with blinded review, the experts were significantly more likely to agree with the obstetric management performed (P < .001) and with the mode of delivery (P < .001) when informed about the neonatal outcome and were less likely to conclude that an error had been made (P < .001) or to establish a link with potential cerebral palsy (P = .003). The experts’ intraobserver agreement for the review of abnormal fetal heart rate tracing and obstetrical management were both mediocre (kappa = 0.46–0.51 and kappa = 0.48–0.53, respectively). The interobserver agreement for the review of abnormal fetal heart rate tracing was low and was not improved by knowledge of the neonatal outcome (kappa = 0.11–0.18). The interobserver agreement for the interpretation of obstetrical management was also low (kappa = 0.08–0.19) but appeared to be improved by knowledge of the neonatal outcome (kappa = 0.15–0.32).

      Conclusion

      The intra- and interobserver agreement among obstetric experts in court for the review of abnormal fetal heart rate tracing and the appropriateness of obstetrical care is poor, suggesting a lack of objectivity of obstetrical expertise as currently performed in court.

      Key words

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