CTG Monitoring of Baby on Admission in labour

Link It is common practice in many hospitals, particularly private hospitals, to routinely attach a CTG to a woman when she is admitted in labour. This is regardless of whether the woman is having a normal, healthy pregnancy or a risk-associated pregnancy.

CTG

Generally, the CTG stays on for at least 20 minutes, or until a normal CTG can be obtained. In some cases, this may be as long as one hour or more. What's more, if there is anything untoward on the admission trace, the CTG will generally remain on for the duration of the labour.

We have known for some time now that in a low-risk, healthy pregnancy, there is no benefit to the baby to having this admission CTG, however it seems to increase the number and type of interventions that the mother experiences in her labour. The study below makes some interesting findings. I want to emphasise that the study relates specifically to an admission CTG in a healthy, low-risk woman. Women with risk-associated pregnancies and their babies would benefit from continuous monitoring in labour.

The admission cardiotocograph (CTG) is a commonly-used screening test consisting of a short (usually 20 minutes) recording of the fetal heart rate (FHR) and uterine activity performed on the mother's admission to the labour ward.

... women allocated to admission CTG ... on average [have] a higher probability of ... caesarean section than women allocated to intermittent auscultation ...

... There was no significant difference in the average treatment effect across included trials between women allocated to admission CTG and women allocated to intermittent auscultation in instrumental vaginal birth ... and fetal and neonatal deaths ...

Women allocated to admission CTG had, on average, significantly higher rates of continuous electronic fetal monitoring during labour ... than women allocated to intermittent auscultatio ...

... the probability is that admission CTG increases the caesarean section rate by approximately 20% ... The findings of this review support recommendations that the admission CTG not be used for women who are low risk on admission in labour. Women should be informed that admission CTG is likely associated with an increase in the incidence of caesarean section without evidence of benefit.

In my practice, women are informed of the monitoring options available to them so that they can make an informed choice about the method that they would prefer (doppler or CTG). The evidence supports the use of the doppler for women having healthy, low-risk births, and continuous CTG monitoring for women whose pregnancies have an identified risk. Doppler

The doppler can be used in any position, and many are waterproof so women can labour in the bath or shower without interruption. Newer forms of continuous monitoring also enable women to be upright and mobile in labour, and are also waterproof so that women can labour in the bath.

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