Interprétation de l'enregistrement du rythme cardiaque fœtal : estimation de la variabilité intra-individuelle

Abstract : Objectives: The fetal heart rate (FHR) monitoring is a mean for surveil of the fetal well-being, its good interpretation allows to highlight possible anomalies which can reveal a fetal asphyxiation. Several studies find an inter-individual variability but also intra-individual interpretation. The main objective of this report is to estimate the variability of intra-individual interpretation of the fetal heart rate monitoring outside any clinical context. Material and methods: It is about a transverse study of reproductibility made in a single maternity, by a student midwife at the end of cursus. Overall, 95 tracings were analyzed and interpreted on two separate occurence by the same observer one month apart. The agreement between the two analysis was calculated by Cohen's Kappa coefficient. The interpretation was made according to the classification of the CNGOF (Collège National des Gynécologues-Obstétriciens Français) established on the analysis of 14 parameters and allowing the classification in 5 global categories. Results: All the found Kappa values were matching a qualified agreement of « very low » ( κ = -0,04) to « high » (κ=0,75). Three parameters on 14 studied reached Kappa considered « high », seven were considered as « moderate » and four parameters of « very low » to « mediocre ». Conclusion: There is a variability of intra-individual interpretation in the analysis of the fetal heart rate monitoring although the objectivity of the study not taking into account the clinical context. This variability is more or less important according to the parameter, but remains disappointing. In reality a few FHR are analyzed unconsciously of the clinical context, the subjectivity and the experience of each one constitute a parameter to be considered in our obstetric practice.
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Submitted on : Thursday, July 28, 2016 - 11:37:20 AM
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Manon Courtine. Interprétation de l'enregistrement du rythme cardiaque fœtal : estimation de la variabilité intra-individuelle. Gynécologie et obstétrique. 2016. ⟨dumas-01349659⟩



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