Professional Documents
Culture Documents
Continuous Cardiotocography WHO
Continuous Cardiotocography WHO
Continuous Cardiotocography WHO
With the exception of reduction in the incidence of neonatal seizures, there were no short- or long-term benefits of routine continuous electronic fetal monitoring. The use of electronic fetal monitoring was associated with significant increases in the rates of caesarean section and assisted vaginal delivery. RHL Commentary by ardin !M
continuous CT" with or without fetal scalp sample (6! were handled using an arbitrary division of the number of controls to avoid double-counting when comparing women in this group with both experimental groups. These data should also be interpreted cautiously since controls were divided into two non-randomized groups, which could wea3en the statistical power and 2uality of the original trial. . Continuous versus intermittent CT" 8ased on one trial which included 6966 women at low to moderate ris3 for complications, no significant differences were found between continuous CT" and intermittent CT" (/!.. 5owever, a trend favourable to intermittent CT" could be observed for most of the outcomes evaluated in the review (comparison 9/!, including caesarean section :relative ris3 (;;! .+<, </= confidence interval (C&! 9.76- .<->, instrumental vaginal birth (;; . ., </= C& 9.<+- .6.!, 'pgar score less than seven at five minutes (;; +../, </= C& 9.-9-<.<-! and admission to ?eonatal &ntensive Care @nit (?&C@! (;; .,6, </= C& 9.< - .<7!. .+ Continuous CT" versus intermittent auscultation 1f the eleven trials in this comparison only two had ade2uate allocation concealment ( , , 6 women!, five were unclear (,9,+ women!, and four had inade2uate allocation concealment ( - +,/ women!. There were no differences in perinatal death, hypoxic encephalopathy and neurodevelopmental disability at + months of age. The meta-analysis of nine trials showed a decrease of /9= in neonatal seizures (;; 9./9, </= C& 9., -9.79!. There was a trend towards increased cerebral palsy with continuous CT" (;; .-6, </= C& 9.<--,. !. This result is, however, strongly influenced by one small trial, with ,/= of the cases excluded after randomization (birth weight A -/9 g!, analysing data from the remaining cohort of neonates with birth weight between -99- -/9 g (. -!. 'n overall statistically significant increase in caesarean sections (;; ..., </= C& .,9+. ,! and instrumental vaginal deliveries (;; . ., </= C& .9 - .,+! in the continuous CT" group, are also presented by the authors of the review.
many years ago. Boreover, while continuous CT" is widely used in developed countries, its use in many under-resourced settings is infre2uent.
.# RE'E)RCH
'lthough neonatal seizures were significantly decreased by the use of continuous CT" compared with intermittent auscultation, the factors behind this reduction are not 3nown. To investigate such factors and their potencial long-term conse2uences, trials with long-term infant follow up are needed. Boreover, the use of continuous CT" in many hospitals in developing countries, is not a standard procedure and sometimes is never performed. &nstead, a combination of intermittent CT", with intermittent auscultation using handheld devices or (inard stethoscope between recording periods is in many cases seen and accepted as standard practice. This combination allows to maximise the use of the often scarce number of cardiotocographs and consumables. Comparisons of continuous versus intermittent CT" did not have sufficient power to detect differences between groups. 4uture ade2uately powered ;CTs should explore the possibility of comparing the two abovementioned variations of the method in moderate to high ris3 patients. This comparison should include total health costs evaluation ta3ing into consideration machines, consumables and maintenance of the e2uipment, as well as the need of proper training on the interpretation of results. ;CTs evaluating the performance of continuous CT" compared to &' in low to highris3 pregnancies with regard to long-term outcomes, cerebral palsy and
neurodevelopmental disability should be encouraged. Baternal and health providersD views and satisfaction should also be considered.
References
'lfirevic E, )evane ), "yte "BF. Continuous cardiotocography (CT"! as a form of electronic fetal monitoring (04B! for fetal assessment during labour (Cochrane ;eview!. The Cochrane Database of Systematic Reviews &ssue ,, +99.%Chichester, @G$ Hohn Wiley I Cons. Thac3er C8, Ctroup ), Chang B. Continuous electronic heart rate monitoring for fetal assessment during labor. The Cochrane Database of Systematic Reviews &ssue +, +99 %Chichester, @G$ Hohn Wiley I Cons. Feveno GH, Cunningham 4", ?elson C, ;oar3 BF, Williams BF, "uzic3 )C, et al. ' prospective comparison of selective and universal electronic fetal monitoring in ,6,<</ pregnancies. New England Journal of Medicine <7.%, /$. /-. <. 5aver3amp '), 1rleans B, Fangendoerfer C, Bc4ee H, Burphy H, Thompson 50. ' controlled trial of the differential effects of intrapartum fetal monitoring. American Journal of bstetrics and !ynecology <-<% ,6$,<<6 +. 5erbst ', &ngemarsson &. &ntermittent versus continuous electronic fetal monitoring in labour$ a randomized study. "ritish Journal of bstetrics and !ynaecology <<6% 9 $..,-..7. Futhy )', Chy GG, van 8elle ", Farson 08, 5ughes H(, 8enedetti TH, et al. ' randomized trial of electronic fetal monitoring in preterm labor. bstetrics and !ynecology <7-%.<$.7--.</. Chy GG, Futhy )', 8ennett 4C, Whitfield B, Farson 08, van 8elle ", et a&. 0ffects of electronic fetal heart rate monitoring, as compared with periodic auscultation, on the neurologic development of premature infants. New England Journal of Medicine <<9%,++$/77-/<,. ?eilson H(. 4etal electrocardiogram (0C"! for fetal monitoring during labour. The Cochrane Database of Systematic Reviews &ssue +, +99,%Chichester, @G$ Hohn Wiley I Cons. ;oyal College of 1bstetricians and "ynaecologists (;C1"!. @se 1f 0lectronic 4etal Bonitoring$ The use and interpretation of cardiotocography in intrapartum fetal surveillance. 0vidence-based Clinical "uideline ?umber 7. #ondon$ Royal College of bstetricians and !ynaecologists %ress%@G, +99 . 'zhar ?', ?eilson H(. ;andomised trial of electronic intrapartum fetal heart rate monitoring with fetal blood sampling versus intermittent auscultation in a developing country. "ritish Journal of bstetrics and !ynaecology +99 % (unpublished data extracted from Cochrane systematic review!$Chichester, @G$ Hohn Wiley I Cons.
This document should be cited as$ ?ardin HB. Continuous cardiotocography (CT"! as a form of electronic monitoring (04B! for fetal assessment during labour$ ;5F commentary (last revised$ < Hanuary +99-!. The &' Re(roductive 'ealth #ibrary% "eneva$ World 5ealth 1rganization.