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Evidence summaries

Continuous Cardiotocography (Ctg) for Fetal Assessment during Labour

Continuous CTG during labour is effective in reducing neonatal seizures compared with intermittent auscultation. However, continuous CTG may not reduce infant mortality or cerebral palsy. It appears to increase caesarean sections and instrumental vaginal births. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 13 trials involving over 37 000 women. Continuous CTG showed no difference compared to intermittent auscultation in overall perinatal death rate (RR 0.85, 95% CI 0.59 to 1.23, 11 trials, n = 33 513) or in cerebral palsy (RR 1.75, 95% CI 0.84 to 3.63, 2 trials, n = 13 252), although it was associated with a halving of neonatal seizures (RR 0.50, 95% CI 0.31 to 0.80, 10 trials, n = 32 386). Caesarean sections rates were increased with continuous CTG compared with intermittent auscultation (RR 1.63, 95% CI 1.29 to 2.07, 11 trials, n =18 861), also instrumental vaginal births were increased (RR 1.15, 95% CI 1.01 to 1.33, 10 trials, n = 18 615). The 2 high quality trials were consistent with overall results. Access to fetal blood sampling did not appear to influence any prespecified outcome.

Authors' comment: In order to test the effect of continuous CTG on mortality more than 50 000 women would have to be randomised. Cerebral palsy is more often caused by antepartum, rather than intrapartum, events, and neonatal seizures may have long-term consequences other than cerebral palsy.

    References

    • Alfirevic Z, Devane D, Gyte GM. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev 2006 Jul 19;3:CD006066 [Review content assessed as up-to-date: 3 February 2017]. [PubMed]

Primary/Secondary Keywords