Clinical practice guidelines for intrapartum cardiotocography interpretation: A systematic review
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Published on: January 27, 2023
James Brown1,2, Dhusyanthy Kanagaretnam1, Monica Zen1
1Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia.
Insights
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.
Background:
Clinical practice guidelines on intrapartum cardiotocography (CTG) interpretation provide structured tools to detect fetal hypoxia. Despite frequent use of different guidelines, little is known about their comparable consistency. We sought to appraise guidelines relevant to intrapartum CTG interpretation and summarise consensus and non-consensus recommendations.
Aims:
To compare existing intrapartum CTG interpretation guidelines.
Materials And Methods:
We searched PubMed, CINAHL, Cochrane, Embase, guideline databases and websites of guideline development institutions using terms 'cardiotocography', 'electronic fetal/foetal monitoring', and 'guideline' or equivalent term. The search was restricted to English-language articles published between January 1980 and January 2023 and excluded animal studies. The initial search yielded 2128 articles with 1253 unique citations. Guidelines were included if they: used English as the reporting language; included CTG interpretation criteria or guidelines as a primary objective; were published or updated since 1980; and were the most recently updated publications when multiple versions were identified.
Results:
Nineteen studies were considered for full review, and 13 met inclusion criteria. Two reviewers independently assessed guideline quality using the AGREE II instrument, and synthesised consensus and non-consensus recommendations using the content analysis approach. Most guidelines employed a three-tier interpretation framework. There were significant differences between the guidelines for relative importance of key CTG features such as accelerations, decelerations and variability, with respect to the outcome of fetal hypoxia.
Conclusions:
There are significant differences between key intrapartum CTG interpretation guidelines currently being used. Greater consistency is needed across CTG interpretation guidelines to improve the quality of data, clinical governance, monitoring of outcomes, and to support future developments.
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