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Am J Perinatol 2012; 29(06): 409-414
DOI: 10.1055/s-0032-1304820
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Measurement of Fetal Heart Rate Variability on an Electronic Monitor Using a Prototype Electronic Ruler

Lianna M. Hall
1   Department of Mechanical Engineering, Tufts University, Medford, Massachusetts
,
Daniel J. Hannon
1   Department of Mechanical Engineering, Tufts University, Medford, Massachusetts
,
Gary G. Leisk
1   Department of Mechanical Engineering, Tufts University, Medford, Massachusetts
,
Adam J. Wolfberg
2   Department of Obstetrics and Gynecology, Division of Maternal–Fetal Medicine, Tufts Medical Center, Boston, Massachusetts
,
Michael D. House
2   Department of Obstetrics and Gynecology, Division of Maternal–Fetal Medicine, Tufts Medical Center, Boston, Massachusetts
› Author Affiliations
Further Information

Publication History

28 June 2011

08 November 2011

Publication Date:
07 March 2012 (online)

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Abstract

Objective To develop a prototype electronic ruler for assessment of fetal heart rate (FHR) variability on an electronic monitor and test its reliability and accuracy.

Study Design A prototype electronic ruler was designed and developed for assessment of FHR variability on electronic monitors. The electronic ruler consisted of horizontal bands that were sized and colored to embed the four FHR variability categories. The reliability and accuracy of using the electronic ruler to assess FHR variability was studied with expert clinicians.

Results Intrarater and interrater reliability was moderate for both the electronic ruler and paper strips. The amplitude measurement accuracy of expert variability assessment compared with a gold standard was significantly improved (p < 0.001) with the electronic ruler versus paper strips. The accuracy of subjects’ FHR variability category responses compared with the gold standard revealed no significant difference (p = 0.50) using either display type.

Conclusion Performance of the electronic ruler was equivalent to paper strips, which may aid assessment of variability on electronic monitors as paper strips become less prevalent.

Keywords

electronic fetal monitoring - electronic medical records - fetal heart rate interpretation - fetal heart rate variability - human factors engineering
 

  • References

  • 1 Martin JA, Hamilton BE, Sutton PD , et al. Births: final data for 2006. Natl Vital Stat Rep 2009; 57 (7) 1-104
    PubMedGoogle Scholar
  • 2 American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 106: intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. Obstet Gynecol 2009; 114: 192-202
    Google Scholar
  • 3 Wolfberg AJ, Derosier DJ, Roberts T , et al. A comparison of subjective and mathematical estimations of fetal heart rate variability. J Matern Fetal Neonatal Med 2008; 21: 101-104
    CrossrefPubMedGoogle Scholar
  • 4 Chauhan SP, Klauser CK, Woodring TC, Sanderson M, Magann EF, Morrison JC. Intrapartum nonreassuring fetal heart rate tracing and prediction of adverse outcomes: interobserver variability. Am J Obstet Gynecol 2008; 199: 623 , e1–e5
    PubMedGoogle Scholar
  • 5 Devane D, Lalor J. Midwives’ visual interpretation of intrapartum cardiotocographs: intra- and inter-observer agreement. J Adv Nurs 2005; 52: 133-141
    CrossrefPubMedGoogle Scholar
  • 6 Lotgering FK, Wallenburg HCS, Schouten HJA. Interobserver and intraobserver variation in the assessment of antepartum cardiotocograms. Am J Obstet Gynecol 1982; 144: 701-705
    PubMedGoogle Scholar
  • 7 Bernardes J, Costa-Pereira A, Ayres-de-Campos D, van Geijn HP, Pereira-Leite L. Evaluation of interobserver agreement of cardiotocograms. Int J Gynaecol Obstet 1997; 57: 33-37
    CrossrefPubMedGoogle Scholar
  • 8 Donker DK, van Geijn HP, Hasman A. Interobserver variation in the assessment of fetal heart rate recordings. Eur J Obstet Gynecol Reprod Biol 1993; 52: 21-28
    CrossrefPubMedGoogle Scholar
  • 9 Macones GA, Hankins GD, Spong CY, Hauth J, Moore T. The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring: update on definitions, interpretation, and research guidelines. Obstet Gynecol 2008; 112: 661-666
    CrossrefPubMedGoogle Scholar
  • 10 U. S. Committee on Ways and Means. Title IV—Health Information Technology for Economic and Clinical Health Act. Available at: http://waysandmeans.house.gov/media/pdf/110/hit2.pdf . Accessed November 2, 2009
    PubMedGoogle Scholar
  • 11 Muthard EK. The Contaminating Influence of Display Size on Flight Control, Risk Assessment, and Route Selection. Proceedings of the Human Factors and Ergonomics Society 49th Annual Meeting, September 26 to 30, 2005, Orlando, FL: 73–77
    PubMedGoogle Scholar
  • 12 Hall L. Prototype electronic displays for improved visual interpretation of fetal heart rate variability [master's thesis]. Medford, MA: Tufts University; 2010
    Google Scholar
  • 13 Wickens CD, Hollands JG. Engineering Psychology and Human Performance. 3rd ed. Upper Saddle River, NJ: Prentice Hall; 2000
    Google Scholar
  • 14 Tulving E, Schacter DL, Stark HA. Priming effects in word-fragment completion are independent of recognition memory. J Exp Psychol Learn Mem Cogn 1982; 8: 336-342
    PubMedGoogle Scholar
  • 15 Cohen J. Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 1968; 70: 213-220
    CrossrefPubMedGoogle Scholar
  • 16 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174
    CrossrefPubMedGoogle Scholar
  • 17 Shoukri MM, Asyali MH, Donner A. Sample size requirements for the design of reliability study: review and new results. Stat Methods Med Res 2004; 13: 251-271
    PubMedGoogle Scholar