Use of CTG monitoring: are recommendations suitable?

The National Institute for Clinical Excellence (NICE) guideline for cardiotocograph (CTG) monitoring in labour (NICE, 2001) recommends intermittent monitoring for low-risk labours and discourages the use of an admission CTG. The guideline sets out risk factors that would classify a labour as high risk, for which it recommends continuous CTG monitoring. An audit conducted in a consultant-led maternity unit found that nearly a half of the labours were classified as high risk at the onset of labour. Of those classified as low risk, almost half of them went on to have continuous CTG during the course of labour. The majority of the reasons given by the midwives agree with indications specified by NICE. Midwives in the unit where the audit took place showed good compliance with the guidelines, except in the case of admission CTGs. Just under half those classified as low risk were found to have had an admission CTG.