Three things to stop saying about fetal monitoring
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.
Are all fetuses the same?
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.
Would you let ChatGPT interpret your CTG?
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!
Does CTG monitoring during labour save lives?
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.
Being an “outstanding” maternity service means very little
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.
If in doubt, do more of the same?
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?
Should we be using amnioinfusion?
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.
Does CTG monitoring make it harder to have a great birth?
A recent Australian study investigated women’s experiences with various fetal monitoring methods during labor, finding that wired CTG was predominant. First-time mothers reported more CTG use, which correlated with higher emergency cesarean rates and epidural use. Many women felt monitoring negatively impacted their experiences, highlighting a need for improved woman-centered maternity care practices.
Is 40 years long enough?
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.
When evidence fails to change practice
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…
Birth Small Talk 