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Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour

  1. Zarko Alfirevic1,*,
  2. Declan Devane2,
  3. Gillian ML Gyte3

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 31 MAY 2013

Assessed as up-to-date: 31 JAN 2013

DOI: 10.1002/14651858.CD006066.pub2


How to Cite

Alfirevic Z, Devane D, Gyte GML. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD006066. DOI: 10.1002/14651858.CD006066.pub2.

Author Information

  1. 1

    The University of Liverpool, Department of Women's and Children's Health, Liverpool, UK

  2. 2

    National University of Ireland Galway, School of Nursing and Midwifery, Galway, Ireland

  3. 3

    The University of Liverpool, Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, Liverpool, UK

*Zarko Alfirevic, Department of Women's and Children's Health, The University of Liverpool, First Floor, Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool, L8 7SS, UK. zarko@liverpool.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions), comment added to review
  2. Published Online: 31 MAY 2013

SEARCH

[Figure 1]
Figure 1. Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
[Figure 2]
Figure 2. Funnel plot of comparison: 1 Continuous CTG versus intermittent auscultation, outcome: 1.1 Perinatal mortality (primary outcome).
[Figure 3]
Figure 3. Funnel plot of comparison: 1 Continuous CTG versus intermittent auscultation, outcome: 1.2 Neonatal seizures (primary outcome).
[Figure 4]
Figure 4. Funnel plot of comparison: 1 Continuous CTG versus intermittent auscultation, outcome: 1.4 Caesarean section (primary outcome).
[Figure 5]
Figure 5. Funnel plot of comparison: 1 Continuous CTG versus intermittent auscultation, outcome: 1.5 Instrumental vaginal birth (primary outcome).
[Analysis 1.1]
Analysis 1.1. Comparison 1 Continuous CTG versus intermittent auscultation, Outcome 1 Perinatal mortality (primary outcome).
[Analysis 1.2]
Analysis 1.2. Comparison 1 Continuous CTG versus intermittent auscultation, Outcome 2 Neonatal seizures (primary outcome).
[Analysis 1.3]
Analysis 1.3. Comparison 1 Continuous CTG versus intermittent auscultation, Outcome 3 Cerebral palsy (primary outcome).
[Analysis 1.4]
Analysis 1.4. Comparison 1 Continuous CTG versus intermittent auscultation, Outcome 4 Caesarean section (primary outcome).
[Analysis 1.5]
Analysis 1.5. Comparison 1 Continuous CTG versus intermittent auscultation, Outcome 5 Instrumental vaginal birth (primary outcome).
[Analysis 1.6]
Analysis 1.6. Comparison 1 Continuous CTG versus intermittent auscultation, Outcome 6 Cord blood acidosis (primary outcome).
[Analysis 1.7]
Analysis 1.7. Comparison 1 Continuous CTG versus intermittent auscultation, Outcome 7 Any pharmacological analgesia (primary outcome).
[Analysis 1.8]
Analysis 1.8. Comparison 1 Continuous CTG versus intermittent auscultation, Outcome 8 Hypoxic ischaemic encephalopathy.
[Analysis 1.9]
Analysis 1.9. Comparison 1 Continuous CTG versus intermittent auscultation, Outcome 9 Neurodevelopmental disability at at least 12 months of age.
[Analysis 1.10]
Analysis 1.10. Comparison 1 Continuous CTG versus intermittent auscultation, Outcome 10 Apgar score < 7 at 5 minutes.
[Analysis 1.11]
Analysis 1.11. Comparison 1 Continuous CTG versus intermittent auscultation, Outcome 11 Apgar score < 4 at 5 minutes.
[Analysis 1.12]
Analysis 1.12. Comparison 1 Continuous CTG versus intermittent auscultation, Outcome 12 Neonatal ICU admissions.
[Analysis 1.13]
Analysis 1.13. Comparison 1 Continuous CTG versus intermittent auscultation, Outcome 13 Fetal blood sampling.
[Analysis 1.14]
Analysis 1.14. Comparison 1 Continuous CTG versus intermittent auscultation, Outcome 14 Damage/infection from scalp electrode or scalp sampling.
[Analysis 1.15]
Analysis 1.15. Comparison 1 Continuous CTG versus intermittent auscultation, Outcome 15 Caesarean section for abnormal FHR pattern and/or acidosis.
[Analysis 1.16]
Analysis 1.16. Comparison 1 Continuous CTG versus intermittent auscultation, Outcome 16 Instrumental vaginal birth for abnormal CTG or fetal acidosis.
[Analysis 1.17]
Analysis 1.17. Comparison 1 Continuous CTG versus intermittent auscultation, Outcome 17 Spontaneous vaginal birth.
[Analysis 1.18]
Analysis 1.18. Comparison 1 Continuous CTG versus intermittent auscultation, Outcome 18 Epidural analgesia.
[Analysis 1.21]
Analysis 1.21. Comparison 1 Continuous CTG versus intermittent auscultation, Outcome 21 Oxytocin during 1st and/or 2nd stage of labour.
[Analysis 1.27]
Analysis 1.27. Comparison 1 Continuous CTG versus intermittent auscultation, Outcome 27 Length of stay on NICU.
[Analysis 2.1]
Analysis 2.1. Comparison 2 Continuous CTG versus IA (pregnancy risk status - high/low), Outcome 1 Perinatal mortality.
[Analysis 2.2]
Analysis 2.2. Comparison 2 Continuous CTG versus IA (pregnancy risk status - high/low), Outcome 2 Neonatal seizures.
[Analysis 2.3]
Analysis 2.3. Comparison 2 Continuous CTG versus IA (pregnancy risk status - high/low), Outcome 3 Cerebral palsy.
[Analysis 2.4]
Analysis 2.4. Comparison 2 Continuous CTG versus IA (pregnancy risk status - high/low), Outcome 4 Caesarean section.
[Analysis 2.5]
Analysis 2.5. Comparison 2 Continuous CTG versus IA (pregnancy risk status - high/low), Outcome 5 Instrumental vaginal birth.
[Analysis 2.6]
Analysis 2.6. Comparison 2 Continuous CTG versus IA (pregnancy risk status - high/low), Outcome 6 Cord blood acidosis.
[Analysis 2.7]
Analysis 2.7. Comparison 2 Continuous CTG versus IA (pregnancy risk status - high/low), Outcome 7 Any pharmacological analgesia.
[Analysis 3.1]
Analysis 3.1. Comparison 3 Continuous CTG versus IA (onset of labour - spontaneous/induced), Outcome 1 Perinatal mortality.
[Analysis 3.2]
Analysis 3.2. Comparison 3 Continuous CTG versus IA (onset of labour - spontaneous/induced), Outcome 2 Neonatal seizures.
[Analysis 3.3]
Analysis 3.3. Comparison 3 Continuous CTG versus IA (onset of labour - spontaneous/induced), Outcome 3 Cerebral palsy.
[Analysis 3.4]
Analysis 3.4. Comparison 3 Continuous CTG versus IA (onset of labour - spontaneous/induced), Outcome 4 Caesarean section.
[Analysis 3.5]
Analysis 3.5. Comparison 3 Continuous CTG versus IA (onset of labour - spontaneous/induced), Outcome 5 Instrumental vaginal birth.
[Analysis 3.6]
Analysis 3.6. Comparison 3 Continuous CTG versus IA (onset of labour - spontaneous/induced), Outcome 6 Cord blood acidosis.
[Analysis 3.7]
Analysis 3.7. Comparison 3 Continuous CTG versus IA (onset of labour - spontaneous/induced), Outcome 7 Any pharmacological analgesia.
[Analysis 4.1]
Analysis 4.1. Comparison 4 Continuous CTG versus IA (preterm/term labour), Outcome 1 Perinatal mortality.
[Analysis 4.2]
Analysis 4.2. Comparison 4 Continuous CTG versus IA (preterm/term labour), Outcome 2 Neonatal seizures.
[Analysis 4.3]
Analysis 4.3. Comparison 4 Continuous CTG versus IA (preterm/term labour), Outcome 3 Cerebral palsy.
[Analysis 4.4]
Analysis 4.4. Comparison 4 Continuous CTG versus IA (preterm/term labour), Outcome 4 Caesarean section.
[Analysis 4.5]
Analysis 4.5. Comparison 4 Continuous CTG versus IA (preterm/term labour), Outcome 5 Instrumental vaginal birth.
[Analysis 4.6]
Analysis 4.6. Comparison 4 Continuous CTG versus IA (preterm/term labour), Outcome 6 Cord blood acidosis.
[Analysis 4.7]
Analysis 4.7. Comparison 4 Continuous CTG versus IA (preterm/term labour), Outcome 7 Any pharmacological analgesia.
[Analysis 5.1]
Analysis 5.1. Comparison 5 Continuous CTG versus IA (singleton/twin pregnancy), Outcome 1 Perinatal mortality.
[Analysis 5.2]
Analysis 5.2. Comparison 5 Continuous CTG versus IA (singleton/twin pregnancy), Outcome 2 Neonatal seizures.
[Analysis 5.3]
Analysis 5.3. Comparison 5 Continuous CTG versus IA (singleton/twin pregnancy), Outcome 3 Cerebral palsy.
[Analysis 5.4]
Analysis 5.4. Comparison 5 Continuous CTG versus IA (singleton/twin pregnancy), Outcome 4 Caesarean section.
[Analysis 5.5]
Analysis 5.5. Comparison 5 Continuous CTG versus IA (singleton/twin pregnancy), Outcome 5 Instrumental vaginal birth.
[Analysis 5.6]
Analysis 5.6. Comparison 5 Continuous CTG versus IA (singleton/twin pregnancy), Outcome 6 Cord blood acidosis.
[Analysis 5.7]
Analysis 5.7. Comparison 5 Continuous CTG versus IA (singleton/twin pregnancy), Outcome 7 Any pharmacological analgesia.
[Analysis 6.1]
Analysis 6.1. Comparison 6 Continuous CTG versus IA (access to FBS during labour - yes/no), Outcome 1 Perinatal mortality.
[Analysis 6.2]
Analysis 6.2. Comparison 6 Continuous CTG versus IA (access to FBS during labour - yes/no), Outcome 2 Neonatal seizures.
[Analysis 6.3]
Analysis 6.3. Comparison 6 Continuous CTG versus IA (access to FBS during labour - yes/no), Outcome 3 Cerebral palsy.
[Analysis 6.4]
Analysis 6.4. Comparison 6 Continuous CTG versus IA (access to FBS during labour - yes/no), Outcome 4 Caesarean section.
[Analysis 6.5]
Analysis 6.5. Comparison 6 Continuous CTG versus IA (access to FBS during labour - yes/no), Outcome 5 Instrumental vaginal birth.
[Analysis 6.6]
Analysis 6.6. Comparison 6 Continuous CTG versus IA (access to FBS during labour - yes/no), Outcome 6 Cord blood acidosis.
[Analysis 6.7]
Analysis 6.7. Comparison 6 Continuous CTG versus IA (access to FBS during labour - yes/no), Outcome 7 Any pharmacological analgesia.
[Analysis 7.1]
Analysis 7.1. Comparison 7 Continuous CTG versus IA (primiparous/multiparous women), Outcome 1 Perinatal mortality.
[Analysis 7.2]
Analysis 7.2. Comparison 7 Continuous CTG versus IA (primiparous/multiparous women), Outcome 2 Neonatal seizures.
[Analysis 7.3]
Analysis 7.3. Comparison 7 Continuous CTG versus IA (primiparous/multiparous women), Outcome 3 Cerebral palsy.
[Analysis 7.4]
Analysis 7.4. Comparison 7 Continuous CTG versus IA (primiparous/multiparous women), Outcome 4 Caesarean section.
[Analysis 7.5]
Analysis 7.5. Comparison 7 Continuous CTG versus IA (primiparous/multiparous women), Outcome 5 Instrumental vaginal birth.
[Analysis 7.6]
Analysis 7.6. Comparison 7 Continuous CTG versus IA (primiparous/multiparous women), Outcome 6 Cord blood acidosis.
[Analysis 7.7]
Analysis 7.7. Comparison 7 Continuous CTG versus IA (primiparous/multiparous women), Outcome 7 Any pharmacological analgesia.
[Analysis 8.1]
Analysis 8.1. Comparison 8 Continuous CTG versus IA (high-quality studies vs lower-quality studies), Outcome 1 Perinatal mortality.
[Analysis 8.2]
Analysis 8.2. Comparison 8 Continuous CTG versus IA (high-quality studies vs lower-quality studies), Outcome 2 Neonatal seizures.
[Analysis 8.3]
Analysis 8.3. Comparison 8 Continuous CTG versus IA (high-quality studies vs lower-quality studies), Outcome 3 Cerebral palsy.
[Analysis 8.4]
Analysis 8.4. Comparison 8 Continuous CTG versus IA (high-quality studies vs lower-quality studies), Outcome 4 Caesarean section.
[Analysis 8.5]
Analysis 8.5. Comparison 8 Continuous CTG versus IA (high-quality studies vs lower-quality studies), Outcome 5 Instrumental vaginal birth.
[Analysis 8.6]
Analysis 8.6. Comparison 8 Continuous CTG versus IA (high-quality studies vs lower-quality studies), Outcome 6 Cord blood acidosis.
[Analysis 8.7]
Analysis 8.7. Comparison 8 Continuous CTG versus IA (high-quality studies vs lower-quality studies), Outcome 7 Any pharmacological analgesia.
[Analysis 9.4]
Analysis 9.4. Comparison 9 Continuous CTG versus intermittent CTG, Outcome 4 Caesarean section (primary outcome).
[Analysis 9.5]
Analysis 9.5. Comparison 9 Continuous CTG versus intermittent CTG, Outcome 5 Instrumental vaginal birth (primary outcome).
[Analysis 9.6]
Analysis 9.6. Comparison 9 Continuous CTG versus intermittent CTG, Outcome 6 Cord blood acidosis (primary outcome).
[Analysis 9.10]
Analysis 9.10. Comparison 9 Continuous CTG versus intermittent CTG, Outcome 10 Apgar score < 7 at 5 minutes.
[Analysis 9.12]
Analysis 9.12. Comparison 9 Continuous CTG versus intermittent CTG, Outcome 12 Neonatal ICU admissions.
[Analysis 9.15]
Analysis 9.15. Comparison 9 Continuous CTG versus intermittent CTG, Outcome 15 Caesarean section for abnormal FHR pattern and/or acidosis.
[Analysis 9.17]
Analysis 9.17. Comparison 9 Continuous CTG versus intermittent CTG, Outcome 17 Spontaneous vaginal birth.
[Analysis 9.18]
Analysis 9.18. Comparison 9 Continuous CTG versus intermittent CTG, Outcome 18 Epidural analgesia.