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.
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