Cardiotocograph monitoring
Analysis of the RANZCOG Intrapartum Fetal Surveillance guideline reveals significant changes between the 3rd and 5th editions. Key improvements include clear responsibility shifts to clinicians, realistic evidence levels for CTG use, and better evidence organization regarding risk factors.
RANZCOG’s fifth edition guideline highlights prolonged pregnancy (over 41 weeks) as a risk factor for intrapartum fetal compromise. Low-grade evidence suggests a slight increase in the risk of brain injury for babies born after 41 weeks. The guideline sets out professional’s responsibilities to support women to make their own decisions about fetal monitoring methods.
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The recent fifth edition of RANZCOG’s fetal monitoring guideline adopts a new approach, providing more accurate summaries of the quality of their evidence. Although it emphasises women’s autonomy, they have not quite completed the task of shifting decision-making from obstetricians.
Australian folks – are you interested in joining me in a workshop in the new year for a detailed look at how to apply the guideline to your practice?
Fetal heart rate monitoring traditionally involves professionals interpreting patterns, but technology has introduced complex, expensive systems aimed at improving outcomes. Despite this, there are ethical concerns regarding women’s consent and data use. The focus appears to prioritize cost reduction for healthcare systems over meaningful enhancements in maternal and fetal care outcomes.
Fetal blood sampling (FBS) has a long history but faces ongoing debates about its relevance. Current evidence shows poor predictive capabilities, and the reliability of fetal blood lactate testing remains disputed. FBS is another example of a fetal monitoring technology that lacks a firm evidence base.
The introduction of the Fetal Surveillance Education Program (FSEP) has been claimed to improve neonatal outcomes. However, the raw data suggests otherwise. A comprehensive literature review indicates inconsistent evidence for CTG training benefits. CTG education should not be mandatory!
I have lived through the rapid evolution of digital technologies. While digital tools offer new possibilities, they also raise ethical concerns, particularly with fetal monitoring. We need to talk about the ethics of digital fetal monitoring more than we currently are.
If you have been hanging around Birth Small Talk for more than a moment, you’ll know I’m very focussed on putting the evidence about fetal heart rate monitoring in front of as many people as possible. And you’ll know that this position puts me at odds with a lot of what most people will hear in mainstream maternity services. So I get some pushback from time to time. And even […]
Recent publications on fetal monitoring highlight the rise of artificial intelligence (AI) in interpreting CTG recordings. While advancements promise decision-support systems, rights issues remain. Ploug and colleagues emphasize the need for regulations in AI-driven healthcare to protect people’s rights, urging the integration of these considerations into technology development from the outset.
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