Central fetal monitoring systems, adopted globally, consolidate data on fetal heart rates and uterine contractions for real-time display. A Swedish study compared outcomes during traditional and central monitoring. No significant differences in metabolic acidosis or neonatal outcomes were found. Instrumental birth rates fell, likely due to revised guidelines, questioning the investment in central monitoring without definitive improvements.
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.
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.
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.
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?
Professor Susan Bewley is a professor of obstetrics with an interest in a great many things. I first became aware of her work many years ago, when I saw her writing about the potential links between the timing of cord clamping, cord blood pH testing, fetal monitoring methods, and perinatal outcomes. Susan recently challenged me to summarise the issues in a blog post – so here we go! Setting the […]
All aspects of maternity care arise as consequences of the decisions that imperfect humans make, often structured by imperfect guidelines, derived from an imperfect or absent research base.
CTG monitoring is in use during a woman’s labour. The fetal heart rate pattern is now abnormal. As her maternity professional, you know that the positive predictive value of the CTG is low, and want to avoid caesarean section unless it is going to improve the fetal outcome. And you don’t want to misidentify when caesarean section is a great idea and as a result have an avoidable poor outcome […]
Birth Small Talk 