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

Abstract

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.

Keywords: Cerebral palsy; Fetal monitoring; Meta-analysis; Perinatal mortality; Stillbirth.