Cardiotocograph monitoring
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.
Terms like “happy,” “tired,” and “distressed”have no place in fetal monitoring discussions. Let’s use accurate language to describe fetal health, instead of emotional interpretations.
In the past two decades, standardized approaches to cardiotocography (CTG) interpretation have evolved. They don’t take into account that specific fetal heart rate patterns may vary by fetal sex and age. There is a need for individualised interpretation as standard guidelines may not account for all fetal characteristics, potentially leading to misinterpretation and harm.
The paper assesses the performance of four Large Language Models for interpreting CTG traces of pregnant women. None of them were fit for purpose. Invest in learning about fetal physiology and how to interpret heart rate patterns and don’t delegate this to a computer!
The evidence on CTG monitoring vs intermittent auscultation during labour does NOT prove that CTG significantly reduces stillbirth or neonatal mortality rates, in either low or high-risk populations. Professionals and academics MUST avoid misleading people about the evidence.
The UK has experienced ongoing maternity care crises. A study of UK maternity services showed that quality ratings did not correlate with maternal and neonatal outcomes. It is time to question the effectiveness of current quality assessment processes and measures.
Continuous fetal monitoring (CFM) technologies are currently being developed for high-risk pregnancies. CFM includes monitoring fetal heart rate and movements. There are concerns about signal quality, and there is an urgent need for research to demonstrate whether CFM actually helps. What impact will it have on women and maternity professionals if it is implemented more widely?
Amnioinfusion is a procedure that delivers fluid into the uterus, aimed at improving fetal outcomes during labor, particularly when decelerations occur. A recent study found a significant reduction in total deceleration area post-amnioinfusion but lacked a control group. Caution is advised before widespread adoption of this practice.
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