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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

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References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
  5. References to other published versions of this review
Athens 1993 {published and unpublished data}
  • Vintzileos A, Nochimson D, Guzman E, Knuppel R. Comparison of intrapartum electronic fetal heart rate monitoring vs intermittent auscultation in detecting fetal acidemia at birth. American Journal of Obstetrics and Gynecology 1995;172:367.
  • Vintzileos AM, Antsaklis A, Varvarigos I, Papas C, Sofatzis I, Montgomery JT. A randomized trial of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation. Obstetrics and Gynecology 1993;81:899-907.
  • Vintzileos AM, Antsaklis AJ, Varvarigos I, Karaiskakis P, Gazis I, Pappas C, et al. A prospective randomized trial of intrapartum electronic fetal heart rate monitoring vs intermittent auscultation. American Journal of Obstetrics and Gynecology 1993;168(6):343.
  • Vintzileos AM, Nochimson DJ, Antsaklis A, Varvarigos I, Guzman ER, Knuppel RA. Comparison of intrapartum electronic fetal heart rate monitoring vs intermittent auscultation in detecting fetal acidemia at birth. American Journal of Obstetrics and Gynecology 1995;173:1021-4.
Copenhagen 1985 {published data only}
  • Hansen PK, Smith SF, Nim J, Neldam S, Osler M. Maternal attitudes to fetal monitoring. European Journal of Obstetrics & Gynecology and Reproductive Biology 1985;20:43-51.
  • Neldam S, Osler M, Hansen PK, Nim J, Smith SF, Hertel J. Intrapartum fetal heart rate monitoring in a combined low- and high-risk population: a controlled clinical trial. European Journal of Obstetrics & Gynecology and Reproductive Biology 1986;23:1-11.
  • Neldam S, Osler M, Hansen PK, Nim J, Smith SF, Hertel J. Monitoring of labour with cardiotocography and stethoscopic examination in normal and at risk deliveries. A controlled clinical investigation. Ugeskrift for Laeger 1985;147:2901-7.
Dallas 1986 {published and unpublished data}
  • Leveno KJ, Cunningham FG, Nelson S, Roark ML, Williams ML, Guzick DS, et al. A prospective comparison of selective and universal electronic fetal monitoring in 34,995 pregnancies. New England Journal of Medicine 1986;315:615-9.
  • Leveno KJ, Cunningham FG, Nelson S, Roark ML, Williams ML, Guzick DS, et al. Selected versus universal electronic fetal monitoring: a randomized study of 31,352 women. Proceedings of 6th Annual Meeting of the Society of Perinatal Obstetricians; 1986 January 30-February 1. San Antonio, Texas, USA, 1986:208.
Denver 1976 {published and unpublished data}
  • Haverkamp AD, Thompson HE, McFee JG, Cetrulo C. The evaluation of continuous fetal heart rate monitoring in high-risk pregnancy. American Journal of Obstetrics and Gynecology 1976;125:310-7.
Denver 1979 {published and unpublished data}
  • Haverkamp AD, Orleans M, Langendoerfer S, McFee J, Murphy J, Thompson HE. A controlled trial of the differential effects of intrapartum fetal monitoring. American Journal of Obstetrics and Gynecology 1979;134:399-412.
  • Koszalka MF Jr, Haverkamp AD, Orleans M, Murphy J. The effects of internal electronic fetal heart rate monitoring on maternal and infant infections in high-risk pregnancies. Journal of Reproductive Medicine 1982;27(10):661-5.
  • Langendoerfer S, Haverkamp AD, Murphy J, Nowick KD, Orleans M, Pacosa F, et al. Pediatric follow-up of a randomized controlled trial of intrapartum fetal monitoring techniques. Journal of Pediatrics 1980;97(1):103-7.
Dublin 1985 {published and unpublished data}
  • Boylan P, MacDonald D, Grant AM, Pereira M, Chalmers I. The Dublin randomised controlled trial of intrapartum fetal heart rate monitoring. In: Kunzel W editor(s). Fetal Heart Rate Monitoring. Berlin: Springer Verlag, 1985:231-3.
  • Ellison PH, Foster M, Sheridan-Pereira M, MacDonald D. Electronic fetal heart monitoring, auscultation, and neonatal outcome. American Journal of Obstetrics and Gynecology 1991;164(5 Pt 1):1281-9.
  • Garcia J, Corry M, MacDonald D, Elbourne DR, Grant AM. Mothers' views of continuous electronic fetal heart monitoring and intermittent auscultation in a randomized controlled trial. Birth 1985;12:79-86.
  • Grant A, O'Brien N, Joy MT, Hennessy E, MacDonald D. Cerebral palsy among children born during the Dublin randomised trial of intrapartum monitoring. Lancet 1989;8674:1233-6.
  • Macdonald D, Grant A, Sheridan-Pereira M, Boylan P, Chalmers I. The Dublin randomized controlled trial of intrapartum fetal heart rate monitoring. American Journal of Obstetrics and Gynecology 1985;152:524-39.
Lund 1994 {published and unpublished data}
  • Herbst A, Ingemarsson I. Intermittent versus continuous electronic fetal monitoring in labour: a randomized study. British Journal of Obstetrics and Gynaecology 1994;101(8):663-8.
  • Herbst A, Ingemarsson I. Intermittent vs continuous monitoring in labour. Proceedings of 14th European Congress of Perinatal Medicine; 1994 June 5-8; Helsinki, Finland. 1994:474.
Melbourne 1976 {published and unpublished data}
  • Renou P, Chang A, Anderson I, Wood C. Controlled trial of fetal intensive care. American Journal of Obstetrics and Gynecology 1976;126:470-6.
  • Wood C, Renou P. Fetal heart rate monitoring, Chapter 23. In: Beard RW, Nathanielsz PW editor(s). Fetal Physiology and Medicine. London: Saunders, 1976:471-3.
Melbourne 1981 {published data only}
  • Wood C, Renou P, Oats J, Farrell E, Beischer N, Anderson I. A controlled trial of fetal heart rate monitoring in a low-risk obstetric population. American Journal of Obstetrics and Gynecology 1981;141:527-34.
New Delhi 2006 {published data only}
  • Madaan M, Trivedi SS. Intrapartum electronic fetal monitoring vs. intermittent auscultation in postcesarean pregnancies. International Journal of Gynecology & Obstetrics 2006;94(2):123-5.
Pakistan 1989 {unpublished data only}
  • Azhar NA, Neilson JP. Randomised trial of electronic intrapartum fetal heart rate monitoring with fetal blood sampling versus intermittent auscultation in a developing country. Personal communication 2001.
Seattle 1987 {published and unpublished data}
  • Killien MG, Shy K. A randomized trial of electronic fetal monitoring in preterm labor: mother's views. Birth 1989;16:7-12.
  • Larson EB, van Belle G, Shy KK, Luthy DA, Strickland D, Hughes JP. Fetal monitoring and predictions by clinicians: observations during a randomized clinical trial in very low birth weight infants. Obstetrics and Gynecology 1989;74:584-9.
  • Luthy DA, Shy KK, van Belle G, Larson EB, Hughes J, Benedetti TJ, et al. A randomized trial of electronic fetal heart rate monitoring in infants of low birth weight. Proceedings of 6th Annual Meeting of the Society of Perinatal Obstetricians; 1986 January 30-February 1. San Antonio, Texas, USA, 1986:207.
  • Luthy DA, Shy KK, van Belle G, Larson EB, Hughes JP, Benedetti TJ, et al. A randomized trial of electronic fetal monitoring in preterm labor. Obstetrics and Gynecology 1987;69(5):687-95.
  • Shy KK, Luthy DA, Bennett FC, Whitfield M, Larson EB, van Belle G, et al. Effects of electronic fetal heart rate monitoring, as compared with periodic auscultation, on the neurologic development of premature infants. New England Journal of Medicine 1990;322(9):588-93.
Sheffield 1978 {published and unpublished data}
  • Kelso IM, Parsons RJ, Lawrence GF, Arora SS, Edmonds DK, Cooke CD. An assessment of continuous fetal heart rate monitoring in labor: a randomized trial. American Journal of Obstetrics and Gynecology 1978;131:526-31.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
  5. References to other published versions of this review
Harare 1994 {published and unpublished data}
  • Mahomed K, Nyoni R, Mlambo T, Jacobus E, Kasule J. Intrapartum foetal heart rate monitoring - continuous electronic vs intermittent doppler - a randomised controlled trial. Central African Journal of Medicine 1992;38:458-62.
  • Mahomed K, Nyoni R, Mulambo T, Kasule J, Jacobus E. Randomised controlled trial of intrapartum fetal heart rate monitoring. BMJ 1994;308:497-500.
Ioannina 2001 {published data only}
  • Stefos T, Sotiriadis A, Tsirkas P, Korkontzelos I, Papadimitriou D, Lolis D. Evaluation of fetal heart monitoring in the first stage of labor. Journal of Maternal-Fetal Medicine 2001;10:48-51.
Manchester 1982 {published data only}
  • D'Souza SW, Black P, MacFarlane T. Fetal scalp damage and neonatal jaundice: a risk of routine fetal scalp electrode monitoring. Journal of Obstetrics and Gynaecology 1982;2:161-4.
North America 2000 {published data only}
  • Garite TJ, Dildy GA, McNamara H, Nageotte MP, Boehm FH, Dellinger EH, et al. A multicenter controlled trial of fetal pulse oximetry in the intrapartum management of nonreassuring fetal heart rate patterns. American Journal of Obstetrics and Gynecology 2000;183:1049-58.

References to studies awaiting assessment

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
  5. References to other published versions of this review
Greece 2012 {published data only}
  • Siristatidis C, Kassanos D, Salamalekis G, Creatsa M, Chrelias C, Creatsas G. Cardiotocography alone versus cardiotocography plus Doppler evaluation of the fetal middle cerebral and umbilical artery for intrapartum fetal monitoring: A Greek prospective controlled trial. Journal of Maternal-Fetal and Neonatal Medicine 2012;25(7):1183-7.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
  5. References to other published versions of this review
ACOG 1995
  • American College of Obstetricians and Gynecologists. ACOG technical bulletin. Fetal heart rate patterns: monitoring, interpretation, and management. Number 207. July 1995 (replaces No. 132, September 1989). International Journal of Gynecology & Obstetrics 1995;51(1):65-74.
Bayley 1993
  • Bayley N. Bayley Scales of Infant Development. 2nd edition. USA: Harcourt Brace & Company, 1993.
Carbone 1997
  • Carbone B, Langer B, Goffinet F, Andibert F, Tardiff D, Le Goueff F, et al. Multicenter study on the clinical value of fetal pulse oximetry and fetal blood analysis. American Journal of Obstetrics and Gynecology 1997;17:593-8.
Chen 2011
  • Chen H-Y, Chauhan SP, Ananth CV, Vintzileos AM, Abuhamad AZ. Electronic fetal heart rate monitoring and its relationship to neonatal and infant mortality in the United States. American Journal of Obstetrics and Gynecology 2011;204:491.e1-10.
Dennis 1978
Derham 1985
  • Derham RJ, Matthews TG, Clarke TA. Early seizures indicate quality of perinatal care. Archives of Disease in Childhood 1985;60:809-13.
Devane 2005
Devane 2012
East 2007
East 2013
Enkin 2000
  • Enkin M, Keirse MJNC, Neilson J, Crowther C, Duley L, Hodnett E, et al. A Guide to Effective Care in Pregnancy and Childbirth. 3rd Edition. Oxford: Oxford University Press, 2000.
Estan 1997
  • Estan J, Hope P. Unilateral neonatal cerebral infarction in full term infants. Archives of Disease in Childhood. Fetal and Neonatal Edition 1997;76:F88-F93.
Gamble 2007
Garcia 1985
Gibb 1992
  • Gibb D, Arulkumaran S. Fetal Monitoring in Practice. Oxford: Butterworth-Heinemann Ltd, 1992.
Grant 1989a
  • Grant A. Monitoring the fetus during labour. Effective Care in Pregnancy and Childbirth. Chalmers I, Enkin M, Keirse MJNC. Oxford: Oxford University Press, 1989:846-82.
Higgins 2005
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Higgins 2008
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Keegan 1985
  • Keegan KA Jr, Waffarn F, Quilligan EJ. Obstetric characteristics and fetal heart rate patterns of infants who convulse during the newborn period. American Journal of Obstetrics and Gynecology 1985;153:732-7.
Killien 1989
Lawn 2005
Lie 2010
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Lien 1995
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Lindström 2006
Liston 2002
  • Liston R, Crane J, Hamilton E, Hughes O, Kuling S, MacKinnon C, et al. SOGC Clinical Practice Guidelines: fetal health surveillance in labour I. Journal of Obstetrics and Gynaecology Canada: JOGC 2002;24(3):250-76.
Luttkus 2004
  • Luttkus AK, Noren H, Stupin JH, Blad S, Arulkumaran S, Erkkola R, et al. Fetal scalp pH and ST analysis of the fetal ECG as an adjunct to CTG. A multicenter, observational study. Journal of Perinatal Medicine 2004;32:486-94.
MCHRC 1997
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MCHRC 1998
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MCHRC 1999
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Mozurkewich 2000
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Munro 2004
  • Munro J, Soltani H, Layhe N, Watts K, Hughes A. Can women relate to the midwifery behind the machines? An exploration of women's experience of electronic fetal monitoring: cross-sectional survey in three hospitals. Normal labour and birth: 2nd Research Conference; 2004 June 9-11; University of Central Lancashire. 2004.
NCCWCH 2008
  • National Collaborating Centre for Women’s and Children’s Health. Intrapartum care: care of healthy women and their babies during childbirth. London: National Collaborating Centre for Women’s and Children’s Health, UK, 2008.
Neilson 2012
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RCOG 2001b
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Stein 2006
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Temple 1995
Thacker 1995
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References to other published versions of this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
  5. References to other published versions of this review
Alfirevic 2006
Thacker 2001
  • Thacker SB, Stroup D, Chang M. Continuous electronic heart rate monitoring for fetal assessment during labor. Cochrane Database of Systematic Reviews 2001, Issue 2. [DOI: 10.1002/14651858.CD000063.pub2]