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Is CTG for higher risk women beneficial?

Todays report on the research is a new paper from authors Kirsten Small, Mary Sidebotham, Jennifer Fenwick and Jenny Gamble… and in the birth research world they are certainly amongst the elite, so you can be sure that you are in for a delicious evidence based treat today. This research paper is called ‘Intrapartum cardiotocograph monitoring and perinatal outcomes for women at risk: and it is a literature review Small, K., Sidebotham, M., Fenwick, J. & Gamble, J (2020) Intrapartum cardiotocograph monitoring and perinatal outcomes for women at risk: Literature review, Women and Birth, 33, p.411-418. So this study wanted to find out if attaching a CTG to a woman who is considered at risk of a poor outcome during labour and birth would change the outcomes for their baby. Firstly the authors defined the problem and thus justified the purpose of their research, they know that caesarean section rates have risen in high-income countries and that one of the potential drivers for this is the widespread use of CTG monitoring. From a birth culture perspective in many high-income countries, Intrapartum CTG monitoring is considered to be indicated for women at risk for poor perinatal outcome, but the authors wanted to discover if this clinical approach was actually evidence based or just done because of the preference of the practitioner. So they did what is called a systematic literature review, which means they methodically sifted through the existing research and found all the research papers that would help them fulfil the purpose of their research – to discover if the use of CTG during labour and birth for at risk women would change outcomes for their babies The authors examined randomised controlled trials and non-experimental research to determine whether CTG rather than intermittent auscultation during labour was associated with changes in perinatal mortality or cerebral palsy rates. They included Nine randomised controlled trials (which are considered to be the scientific panicle of research if you are looking to discover information about outcomes) and 26 non-experimental studies. Then they set to work to understand all this relevant research. What we know is that (CTG) monitoring was introduced in the 1970s. The CTG records and displays the foetal heart rate and uterine tone. Foetal heart rate patterns are considered to provide physiological information regarding oxygenation of the baby. During labour there is a reduction in blood flow though the placenta and to the baby during contractions, this is a normal physiological process and babies are designed to, most of the time tolerate this process. However it is feared by practitioners that this reduction in oxygenation is responsible for some proportion of deaths and cases of cerebral palsy. So CTG was introduced as a screening tool in order to detect foetal hypoxia so that action can be taken. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) Intrapartum Fetal Surveillance guideline acknowledge that evidence from randomised controlled trials (RCTs) do not demonstrate a perinatal bene!t from intrapartum CTG monitoring for infants born to women with risk factors but suggests that non-experimental evidence supports this practice and therefore justifies the guideline’s recommendations for CTG use. However the problem is that what we now know is that the use of CTG is increasing the use of caesarean section but not actually improving outcomes , so the original theory behind the benefits of CTG have not been proven and now with this research, appear to have blown the applicability of this particular screening tool out of the birth water. In fact, the authors of this paper directly dispute the stance of RANZCOG by declaring in this research that, ‘The majority of non-experimental research was at critical risk of bias and should not be relied on to inform practice’ Conclusion: There is an urgent need for well-designed research to consider whether intrapartum cardiotocograph monitoring provides benefits. No RCT in a population of high or moderate risk women demonstrated statistically significant differences in stillbirth, neonatal mortality, or perinatal mortality rates when comparing continuous CTG to intermittent auscultation, however there is an 291% increase risk in cerebral palsy for babies born pre-term who are monitored using CTG. Since its introduction assumptions have been made that intrapartum CTG monitoring would provide maternity professionals with “an essential diagnostic technique in obstetrical practice which improves such fetal outcomes as perinatal mortality, morbidity and neonatal status. But this assumption cannot be supported by research undertaken to date, as of 2019. for more video’s like this subscribe to my youtube channel and follow me @melaniethemidwife on Instagram and facebook, I’m Melanie the Midwife and if you found this helpful, pass it on!