Birth Small Talk

Talking about birth

Is computerised interpretation of the CTG a cost-effective option?

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The INFANT study was a large, multi-centre, randomised controlled trial which aimed to examine whether the addition of computerised interpretation of the CTG improved perinatal outcomes (INFANT Collaborative Group, 2017). The trial recruited 46,042 women who were being monitored by CTG during labour and randomised them to either standard care (clinician interpretation of the CTG only) or the addition of information from INFANT decision-support software that highlights segments of the CTG considered to be abnormal by a computer algorithm. No improvements in perinatal outcome were found, nor were there differences in the use of instrumental birth or caesarean section. 

A new paper has been published in the past week, examining whether the use of the INFANT system was associated with cost savings for the National Health Service (Schroeder et al., 2020). The research examined direct costs to the healthcare system beginning with care provided in labour, and included costs related to healthcare for either the woman or her baby up to 2 years after the birth. There were no differences in the cost of care for women or babies up to discharge from hospital when INFANT was used and when it was not, nor were there differences in care costs for women or babies during the time from discharge to 2 years post birth. 

The authors concluded:

Decision-support software during labour is not associated with additional maternal or infant benefits and over a 2-year period the software did not lead to additional costs or savings to the National Health Service. 

p. F1

To the previous findings of an absence of clinical benefit, this paper adds evidence of an absence of financial benefit from the use of the INFANT system. Use of this computerised CTG interpretation software cannot be supported by current evidence. I wonder how much more evidence will be required before we see maternity services rolling back the implementation of these expensive systems?

INFANT Collaborative Group. (2017, Apr 29). Computerised interpretation of fetal heart rate during labour (INFANT): a randomised controlled trial. The Lancet, 389(10080), 1719-1729. https://doi.org/10.1016/S0140-6736(17)30568-8

Schroeder, E., Yang, M., Brocklehurst, P., Linsell, L., & Rivero-Arias, O. (2020, Aug 12). Economic evaluation of computerised interpretation of fetal heart rate during labour: a cost-consequence analysis alongside the INFANT study. Archived of Diseases in Childhood. Fetal and Neonatal Edition, in press. https://doi.org/10.1136/archdischild-2020-318806

Categories: CTG, EFM, New research

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1 reply

  1. Let’s hope evidence based practice follows publishing of the evidence.

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