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Continuous cardiotocography during labour: Analysis, classification and management.

Ana Pinas1, Edwin Chandraharan2

  • 1St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW 17 0QT, UK.

Best Practice & Research. Clinical Obstetrics & Gynaecology
|July 14, 2015
PubMed
Summary

Continuous electronic fetal monitoring (EFM) via cardiotocograph (CTG) has a high false-positive rate for predicting fetal hypoxia. A physiology-based approach, rather than pattern recognition, may improve perinatal outcomes and reduce interventions.

Keywords:
Fetal Physiological Scorecardiotocography (CTG)fetal ECGfetal physiologyfetal scalp blood samplingintrapartum monitoring

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Area of Science:

  • Obstetrics and Gynecology
  • Fetal Medicine
  • Perinatal Care

Background:

  • Electronic fetal heart rate monitoring (EFM) using cardiotocography (CTG) was introduced to prevent intrapartum hypoxic-ischaemic injury.
  • Despite its widespread use, CTG has a low positive predictive value (approx. 30%) for fetal hypoxia and a high false-positive rate (60%).
  • There has been no demonstrable reduction in cerebral palsy or perinatal deaths since CTG's introduction 45 years ago, alongside increased rates of operative delivery.

Purpose of the Study:

  • To evaluate the effectiveness of cardiotocography (CTG) in predicting intrapartum fetal hypoxia.
  • To highlight the limitations of current CTG interpretation guidelines and their impact on clinical practice.
  • To advocate for a physiology-based approach to fetal heart rate monitoring interpretation.

Main Methods:

  • Review of the literature on electronic fetal monitoring (EFM) and cardiotocography (CTG) effectiveness.
  • Analysis of the positive predictive value and false-positive rates of CTG in predicting fetal hypoxia.
  • Discussion of the limitations of pattern recognition in CTG interpretation and inter-observer variability.

Main Results:

  • Cardiotocography (CTG) demonstrates a low positive predictive value (approx. 30%) for intrapartum fetal hypoxia.
  • The false-positive rate of CTG is high (approx. 60%), leading to potential over-intervention.
  • No significant improvement in perinatal outcomes (cerebral palsy, perinatal deaths) has been observed since CTG's widespread adoption.

Conclusions:

  • Current reliance on visual interpretation and pattern recognition in CTG is associated with significant variability and high false-positive rates.
  • A shift towards a physiology-based approach to interpreting fetal heart rate changes is recommended.
  • Implementing a physiology-based approach may reduce unnecessary operative interventions and improve perinatal outcomes.