It’s time to highlight the serious issue of unconsented fetal monitoring during childbirth, and the widespread misinformation about its safety and efficacy. It’s time to fix the underlying causes – starting with how guidelines are applied in practice.
Analysis of the RANZCOG Intrapartum Fetal Surveillance guideline reveals significant changes between the 3rd and 5th editions. Key improvements include clear responsibility shifts to clinicians, realistic evidence levels for CTG use, and better evidence organization regarding risk factors.
RANZCOG’s fifth edition guideline highlights prolonged pregnancy (over 41 weeks) as a risk factor for intrapartum fetal compromise. Low-grade evidence suggests a slight increase in the risk of brain injury for babies born after 41 weeks. The guideline sets out professional’s responsibilities to support women to make their own decisions about fetal monitoring methods.
The recent fifth edition of RANZCOG’s fetal monitoring guideline adopts a new approach, providing more accurate summaries of the quality of their evidence. Although it emphasises women’s autonomy, they have not quite completed the task of shifting decision-making from obstetricians.
Australian folks – are you interested in joining me in a workshop in the new year for a detailed look at how to apply the guideline to your practice?
Routine cord blood gas analysis – harmful or helpful?
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.
A recent study examined intermittent auscultation during labor in various UK birth settings. It found that local policies exist in most units, but training and competency assessments were inconsistently implemented. The reliance on certain fetal monitoring devices and practices raises concerns, as does the use of outdated training programs and practices.
In a trial comparing fetal blood sampling to digital fetal scalp stimulation for assessing fetal wellbeing, recruitment fell short, concluding early after just 534 participants. Despite showing a significantly lower caesarean section rate with scalp stimulation, the small sample limits the findings. The irony of guidelines undermining evidence development is discussed.
Today’s post shares the back story behind our paper. #CTG #EFM #PerinatalMortality #CP
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Birth Small Talk 