Electronic fetal monitoring
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.
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 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.
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.
The Dublin randomized controlled trial published in July 1985 aimed to determine the effectiveness of continuous fetal monitoring (CTG) over intermittent auscultation during labor. The trial found no significant differences in outcomes for babies. Despite its findings, CTGs remained widely used. It’s time to do something about that.
It’s a valid question. With at least 40 years of evidence showing that CTG monitoring doesn’t improve outcomes, wondering why we are still doing CTGs is a fair question. New research highlights why changing practice is so hard. And I share what I’m going to be doing to make it happen…
The article reviews a recent paper on fetal monitoring during labor by Richmond et al. which lacks a reference list, undermining its educational value. While it identifies some correct points about fetal heart rate interpretations, it perpetuates outdated practices and fails to acknowledge the need for consent in monitoring, thus serving more as promotional content than genuine education.
A recent Finnish study explored HIE and its preventability with CTG use. Findings suggest that timely interventions may have avoided HIE for one in five women with an affected. However, this study does not establish CTG superiority over intermittent auscultation for monitoring fetal health.
When is fetal monitoring not fetal monitoring? #EFM #CTG #LanguageMatters
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