Obstetricians' agreement on fetal prognosis after ultrasound diagnosis of fetal anomalies

Introduction: After ultrasound diagnosis of a severe fetal anomaly is made, difficult decisions may arise regarding obstetric management. Guidelines have been developed to support obstetricians in decision-making. However, it is unknown to what extent in the clinical situation, guidelines are actually supportive. Objectives: We aimed at: (1) determining whether obstetricians in the presence of a fetal anomaly are able to classify fetal prognosis according to guidelines; (2) establishing inter- and intra-observer agreement regarding fetal prognosis. Methods: We used three categories of fetal prognosis: category 1: the infant has no chance of survival and the abnormalities cannot be treated (1.1); or the infant has a chance of extra-uterine survival but post-natal use of life-prolonging medical treatment is considered futile (1.2); category 2: the infant has a chance of extra-uterine survival and post-natal use of life-prolonging medical treatment, if necessary, is considered beneficial. Five senior obstetricians categorized 100 case descriptions of severe fetal abnormalities, which were classified again after five months. Results: Four obstetricians were able to classify 98% or more of cases. In 67% of cases, four or all obstetricians agreed on fetal prognosis. The overall kappa coefficient was 0.48 (moderate agreement). The differences between obstetricians represented systematic differences in opinions on how to classify cases. Intra-observer agreement was 82 to 97%. Conclusion: Obstetricians were usually able to classify fetal prognosis according to guidelines, but in a substantial number of cases, there was a disagreement reflecting systematic differences between obstetricians. Copyright

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