Electronic fetal monitoring
The paper investigates the relationship between umbilical cord size and fetal heart rate patterns during labor. Findings suggest that less Wharton’s jelly correlates with repetitive heart rate decelerations. However, misconceptions about fetal decelerations and their impact on fetal health were noted, along with a lack of evidence for suggested monitoring interventions.
CTG monitoring during vaginal birth after caesarean section (VBAC) is often deemed essential, but evidence suggests it does not prevent uterine rupture. Abnormal fetal heart rate patterns indicating rupture can also occur for other reasons. Therefore, CTG is not mandatory; women should choose their monitoring method based on individual circumstances.
The design of the very first RCT about CTG monitoring is interesting, and it raised a question which we really haven’t ever answered fully. Does the use of CTGs create the very problem they are meant to prevent?
The Dawes Redman system, used for CTG monitoring in pregnancy, aims to predict adverse outcomes. Recent research indicated a low overall accuracy of 54.4%, with high negative predictive values but low positive predictive values, especially in high-risk scenarios, questioning its effectiveness and endorsement in clinical guidelines.
There is a lack discussion surrounding the unconsented use of women’s clinical data for CTG analysis training in AI. Women should know when and how their data is being used, and benefit from their data use when corporations profit from it.
Central fetal monitoring systems gather data from CTG machines and show it in a central place. While aimed at improving outcomes this has not been proven in research. Midwives reported disruptions in response to what was seen at the central monitor, leading to altered care practices focused on documentation over support for birthing women. It is time to pause and think, rather than continue to accept the introduction of these systems.
Women planning a vaginal birth after cesarean (VBAC) often seek to avoid negative experiences with CTG monitoring. This new mini-course offers reliable information on fetal monitoring options during VBAC, cutting risks down to realistic size, and providing communication strategies with care providers.
A Japanese research team compared human and artificial intelligence performance in analyzing CTG data to predict perinatal asphyxia. Clinicians slightly outperformed AI in accurately diagnosing affected babies. However, limitations raise concerns, emphasising the essential role of healthcare professionals over machines in maternity services.
Clinical Decision Support Systems (CDSS) aim to enhance maternity care by improving decision-making consistency and safety. A systematic review points out concerns over potential biases and the effectiveness of CDSS amid varying clinical contexts. More robust research is needed.
Today’s post reflects on a 1959 trial concerning “fetal distress”. It highlights findings that meconium was a critical indicator of poor outcomes, while abnormal fetal heart rates weren’t reliably predictive. Should we be reevaluating current obsessions with CTG use and focusing on alternative clinical markers?
Birth Small Talk 