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
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Article info
Publication history
Published online: October 25, 2019
Accepted:
October 4,
2019
Received in revised form:
October 4,
2019
Received:
August 2,
2019
Identification
Copyright
© 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
