Although the concepts of periodic fetal heart rate and fetal heart rate patterns are new to most obstetricians, with a little instruction they apparently have little difficulty in recognising the various types of fetal heart rate patterns and classifying them into innocuous and ominous groups.(Paul & Hon, 1970, p. 168)
Since Paul and Hon’s overly optimistic paper promised that CTGs would make maternity care better and required little instruction, CTG education has become a big business. It is reasonable to apply a research focus to CTG education and see whether it is a good investment or not. Late last year Kelly et al. (2020) published a systematic literature review which set out to answer the question of whether training in intrapartum CTG monitoring achieves the goal that it promises. Their take home message was that “evidence for the impact of CTG training on neonatal and maternal outcomes is limited, shows inconsistent effects, and is of low overall quality”. The Kelly et al paper should be compulsory reading for all people who design, run, and fund CTG education. The authors have done the science well and argue their position competently.
Professor David Ellwood and I have just published a mini-commentary reflecting on their findings (Small & Ellwood, 2021). Based on the current evidence set out by Kelly and colleagues we argued that stand alone CTG education should not be considered mandatory for maternity clinicians.
Here in Australia, most but not all state health departments require clinicians to have attended the Royal Australian and New Zealand College of Obstetricians and Gynaecologists fetal surveillance education course (known as FSEP) in the past one or two years, and to have achieved a high score (level three). I’m curious to know what happens in other parts of the world. Is CTG education mandated? Who offers the courses? How long are the courses? Is there an exam and what form does it take? How much do you pay to attend? Please add your comment below so we can see what is happening around the world.
Kelly, S., Redmond, P., King, S., Oliver-Williams, C., Lame´, G., Liberati, E. G., Kuhn, I., Winter, C., Draycott, T., Dixon-Woods, M., & Burt, J. (2020). Training in the use of intrapartum electronic fetal monitoring with cardiotocography: Systematic review and meta-analysis. BJOG, in press. https://doi.org/https://doi.org/10.1111/1471-0528.16619
Paul, R. H., & Hon, E. H. (1970, Feb). A clinical fetal monitor. Obstetrics & Gynecology, 35(2), 161-169.
Small, K., & Ellwood, D. (2021). Does training in intrapartum fetal monitoring actually work? BJOG: An International Journal of Obstetrics & Gynaecology, in press. https://doi.org/10.1111/1471-0528.16725