References

ACOG Practice Bulletin No. 106: Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. Obstet Gynecol. 2009; 114:(1)192-202 https://doi.org/10.1097/AOG.0b013e3181aef106

Ayres-de-Campos D, Spong CY, Chandraharan E FIGO consensus guidelines on intrapartum fetal monitoring: Cardiotocography. Int J Gynaecol Obstet. 2015; 131:(1)13-24 https://doi.org/10.1016/j.ijgo.2015.06.020

Cahill AG, Roehl KA, Odibo AO, Macones GA Association of atypical decelerations with acidemia. Obstet Gynecol. 2012; 120:(6)1387-93 https://doi.org/http://10.1097/AOG.0b013e3182733b6e

Electronic Fetal Monitoring.London: Health Education England; 2011

Hamilton E, Warrick P, O'Keeffe D Variable decelerations: do size and shape matter?. J Matern Fetal Neonatal Med. 2012; 25:(6)648-53 https://doi.org/10.3109/14767058.2011.594118

Lewis D, Downe S FIGO consensus guidelines on intrapartum fetal monitoring: Intermittent auscultation. Int J Gynaecol Obstet. 2015; 131:(1)9-12 https://doi.org/10.1016/j.ijgo.2015.06.019

Intrapartum care: Care of healthy women and their babies during childbirth.London: NICE; 2007

National Insitute for Health and Care Excellence. Intrapartum care for healthy women and babies. 2014. http://www.nice.org.uk/guidance/cg190 (accessed 12 August 2016)

London: RCOG; 2012

London: Evidence-based Clinical Guideline Number 8. RCOG; 2001

Sholapurkar SL Intermittent auscultation of fetal heart rate during labour - a widely accepted technique for low risk pregnancies: but are the current national guidelines robust and practical?. J Obstet Gynaecol. 2010; 30:(6)537-40 https://doi.org/10.3109/01443615.2010.484108

Sholapurkar SL The conundrum of vanishing early decelerations in British obstetrics, a step backwards? Detailed appraisal of British and American classifications of fetal heart rate decelerations - fallacies of emphasis on waveform and putative aetiology. J Obstet Gynaecol. 2012; 32:(6)505-11 https://doi.org/10.3109/01443615.2012.689029

Sholapurkar SL Are ‘early’ and ‘late’ fetal heart rate decelerations extinct? A survey of British midwives and analysis of controversies, facts and fiction. British Journal of Midwifery. 2013a; 21:(12)860-6 https://doi.org/10.12968/bjom.2013.21.12.860

Sholapurkar SL Interpretation of British experts’ illustrations of fetal heart rate (FHR) decelerations by Consultant Obstetricians, registrars and midwives: A prospective study—Reasons for major disagreement with experts and implications for clinical practice. Open J Obstet Gynecol. 2013b; 3:(3)454-65 https://doi.org/10.4236/ojog.2013.36085

Sholapurkar SL Intermittent Auscultation in Labor: Could It Be Missing Many Pathological (Late) Fetal Heart Rate Decelerations? Analytical Review and Rationale for Improvement Supported by Clinical Cases. J Clin Med Res. 2015; 7:(12)919-25 https://doi.org/10.14740/jocmr2298w

Amendments in electronic fetal monitoring and intermittent auscultation

02 September 2016
7 min read
Volume 24 · Issue 9

Abstract

Confusion over terminology and disagreement about the best methods make fetal monitoring a controversial topic. Shashikant L Sholapurkar argues that current guidelines may not be robust and that midwives should take an active role in debating and bringing about reforms.

Interpretation of cardiotocography (CTG) remains a controversial topic, despite attempts by the national professional bodies to standardise the terminology and decision-making systems. The National Institute for Health and Care Excellence (NICE, 2014) had the difficult and unenviable task of formulating guidelines given the dearth of good-quality evidence. In some ways, it would be better to have a separate guideline for intrapartum fetal monitoring—as in many other countries—because it is a major specialist subject in itself. This would allow many more specialists with a focused, specific interest and expertise in CTG to be on the panel.

Midwives are, of course, at the frontline of CTG interpretation and intermittent auscultation of fetal heart rate (FHR) during labour—hence they bear the brunt of any major changes and shortcomings of the guidelines. Their CTG interpretation practice has come under increasing scrutiny and regulation, making it one of the leading causes of strain and pressure of the job. Not only do different countries have varying 3-tier systems of CTG interpretation and recommendations, the UK guidelines have themselves undergone significant change (NICE, 2007; 2014). It is worth considering the validity of these changes, implications for midwives and whether midwives should take a more active role in influencing changes in future. British midwives have always been trained to interpret a combination of different FHR parameters in the context of the clinical picture and risk factors, but this remains a complex judgement. This commentary will focus on the interpretation of FHR decelerations (considered centre-stage) on CTG and intermittent auscultation, where there have been amendments in recent years (NICE, 2014).

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