A international team of researchers has recently published a rigorous and comprehensive review of the evidence comparing intermittent auscultation and continuous intrapartum CTG monitoring (Al Wattar et al., 2021). Their paper is published as an open access paper – so even people without access to an institutional library can read it. You’ll find the link in the reference list below.
All up, they identified 33 trials, expanding the scope of their enquiry beyond our paper published last year which focussed on mortality (Small et al., 2020), to also look at caesarean section rates for women, and acidaemia, admission to the nursery and Apgar scores for babies. They also included research about computer analysis of the CTG, fetal scalp lactate and pH, pulse oximetry, and fetal electrocardiogram analysis. They found “none of the evaluated methods was associated with a reduced risk of neonatal acidaemia, neonatal unit admissions, Apgar scores or perinatal death” (p. e468).
I particularly appreciated their approach to framing the language regarding fetal monitoring to normalise intermittent auscultation as the standard. They concluded that “compared with other types of fetal surveillance, intermittent auscultation seems to reduce emergency caesarean deliveries in labour without increasing adverse neonatal and maternal outcomes” (p. e476). The authors suggest that it is time to seriously invest in developing and evaluating new technology to make birth safer, given that CTG technology has not achieved what it set out to do.
Al Wattar, B. H., Honess, E., Bunnewell, S., Welton, N. J., Quenby, S., Khan, K. S., Zamora, J., & Thangaratinam, S. (2021). Effectiveness of intrapartum fetal surveillance to improve maternal and neonatal outcomes: a systematic review and network meta-analysis. Canadian Medical Association Journal, 193(14), E468-E477. https://doi.org/10.1503/cmaj.202538
Small, K. A., Sidebotham, M., Fenwick, J., & Gamble, J. (2020, Sept). Intrapartum cardiotocograph monitoring and perinatal outcomes for women at risk: Literature review. Women and Birth, 33(5), 411-418. https://doi.org/10.1016/j.wombi.2019.10.002
Categories: CTG, EFM, IA, New research, Perinatal mortality
Tags: caesarean section, lactate, pulse oximetry, scalp pH, STAN analysis
5 replies ›
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oh my only complaint here is “seriously invest in developing and evaluating new technology to make birth safer”
Why is the assumption always that we need new tech? Continuity of carer and skilled midwifery are the things shown time and time again to reduce morbidity and mortality. Can we invest in those please!
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Unfortunately, evidence-based medical knowledge that contradicts assumptions and practice usually takes about 17 years to result in procedural change (Slote Z, Wooding S, Grant J, 2011.)
In the case of CTG monitoring, it seems counter-intuitive that intermittent surveillance is better than continuous, plus established staffing and equipment protocols support business as usual.
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