Intrapartum cardiotocograph monitoring and perinatal outcomes for women at risk: Literature review |
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| Affiliation: | 1. School of Nursing and Midwifery, Griffith University, University Drive, Meadowbrook, QLD, 4131, Australia;2. Transforming Maternity Care Collaborative, Southport, QLD, 4215, Australia;3. Women’s & Newborn & Children''s Services, Gold Coast University Hospital, 1 Hospital Blvd, Southport, QLD, 4215, Australia;1. Department of Obstetrics and Gynecology, Máxima MC, P.O. Box 7777, 5500 MB, Veldhoven, the Netherlands;2. Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands;3. Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, the Netherlands;4. Department of Obstetrics and Gynecology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands;5. MMC Academy, Máxima MC, P.O. Box 7777, 5500 MB, Veldhoven, the Netherlands;6. Department of Obstetrics and Gynecology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, the Netherlands;1. Intermountain Healthcare, Salt Lake City, UT;2. University of Utah Health, Salt Lake City, UT;3. Brigham Young University, Salt Lake City, UT;1. Burnet Institute, Australia;2. University of Technology Sydney, Australia;3. Deakin University, Australia;1. Deakin University, Australia;2. Alfred Hospital, Melbourne, Australia;1. Safer Care Victoria, Australia;2. La Trobe University, Australia;1. Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Huddinge, Sweden;2. Department of Obstetrics and Gynecology, Karolinska University Hospital, Sweden;3. Department of Women’s and Children’s Health, Karolinska Institutet, Sweden;4. Department of Neonatology, Karolinska University Hospital, Huddinge, Sweden;5. Department of Obstetrics and Gynecology, Sodersjukhuset, Stockholm, Sweden;1. Second Municipal Hospital for Obstetrics and Gynecology Sheynovo, Sofia, Bulgaria;2. Orthogyn Medical Center, Sofia, Bulgaria;3. National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland;4. Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands |
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| Abstract: | ProblemCaesarean section rates have risen in high-income countries. One of the potential drivers for this is the widespread use of CTG monitoring.BackgroundIntrapartum cardiotocograph monitoring is considered to be indicated for women at risk for poor perinatal outcome.AimThis systematic literature review with meta-analysis examined randomised controlled trials and non-experimental research to determine whether cardiotocograph monitoring rather than intermittent auscultation during labour was associated with changes in perinatal mortality or cerebral palsy rates for high-risk women.MethodsA systematic search for research published up to 2019 was conducted using PubMed, CINAHL, Cochrane, and Web of Science databases. Non-experimental and randomised controlled trial research in populations of women at risk which compared intrapartum cardiotocography with intermittent auscultation and reported on stillbirth, neonatal mortality, perinatal mortality and/or cerebral palsy were included. Relative risks were calculated from extracted data, and meta-analysis of randomised controlled trials was undertaken.FindingsNine randomised controlled trials and 26 non-experimental studies were included. Meta-analysis of pooled data from RCTs in mixed- and high-risk populations found no statistically significant differences in perinatal mortality rates. The majority of non-experimental research was at critical risk of bias and should not be relied on to inform practice. Cardiotocograph monitoring during preterm labour was associated with a higher incidence of cerebral palsy.DiscussionResearch evidence failed to demonstrate perinatal benefits from intrapartum cardiotocograph monitoring for women at risk for poor perinatal outcome.ConclusionThere is an urgent need for well-designed research to consider whether intrapartum cardiotocograph monitoring provides benefits. |
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| Keywords: | Fetal monitoring Perinatal mortality Stillbirth Cerebral palsy Meta-analysis |
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