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Updated: Aug 7, 2025
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Published on: January 27, 2023
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Clinical practice guidelines for intrapartum cardiotocography interpretation: A systematic review
James Brown1,2, Dhusyanthy Kanagaretnam1, Monica Zen1
1Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia.
Summary
Clinical practice guidelines for intrapartum cardiotocography (CTG) interpretation show significant differences in recommendations for detecting fetal hypoxia. Greater consistency is needed across these guidelines for improved fetal monitoring and outcomes.
Area of Science:
- Obstetrics and Gynecology
- Clinical Practice Guidelines
- Fetal Monitoring
Background:
- Intrapartum cardiotocography (CTG) interpretation guidelines aim to detect fetal hypoxia.
- Existing guidelines are frequently used, but their comparative consistency is not well understood.
Approach:
- A systematic literature search was conducted across multiple databases for intrapartum CTG interpretation guidelines published between 1980 and 2023.
- Thirteen guidelines were included and assessed for quality using the AGREE II instrument.
- Content analysis was used to synthesize consensus and non-consensus recommendations.
Key Points:
- Most guidelines utilize a three-tier interpretation framework for CTG.
- Significant variations exist in the emphasis placed on key CTG features (accelerations, decelerations, variability) for identifying fetal hypoxia.
- Differences were noted in the relative importance assigned to specific CTG features across guidelines.
Conclusions:
- There are substantial discrepancies among current intrapartum CTG interpretation guidelines.
- Enhanced consistency across CTG guidelines is crucial for improving data quality, clinical governance, and outcome monitoring.
- Standardization of CTG interpretation guidelines is recommended to support advancements in fetal monitoring.
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