Intrapartum cardiotocograph monitoring and perinatal outcomes for women at risk: Literature review.

PROBLEM: Caesarean section rates have risen in high-income countries. One of the potential drivers for this is the widespread use of CTG monitoring.

BACKGROUND

Intrapartum cardiotocograph monitoring is considered to be indicated for women at risk for poor perinatal outcome.

AIM: This 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.

METHODS

A 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.

FINDINGS: Nine 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.

DISCUSSION: Research evidence failed to demonstrate perinatal benefits from intrapartum cardiotocograph monitoring for women at risk for poor perinatal outcome.

CONCLUSION

There is an urgent need for well-designed research to consider whether intrapartum cardiotocograph monitoring provides benefits.