Cardiotocography in labour: an exploratory analysis of foetal heart rate (FHR) interpretative uniformity in Alto Adige

ABSTRACT

Objective. Cardiotocography (CTG) is a screening tool to monitor foe­tal well-being during labour and delivery. The overall process of in­terpreting CTG during labour is known to be subject to significant in­ter-observer and intra-observer variability and the need to reduce this variability of interpretation has not only a clinical and care role but is of considerable importance for medical-legal reasons. We have report­ed an exploratory analysis of the interpretational variation of the same FHR-tracing recorded during labour by different clinical figures.
Materials and Methods. The aim of this study was to evaluate the uniformity of interpretation of a CTG-tracing in labour performed by medical and obstetrical personnel in a single Italian health-district (Alto Adige).
Results. 40 health-care professionals responded to the questionnaire, 11 of whom were physicians specialized in gynaecology (27.5%) and 29 were in the profession of midwifery (72.5%).
There was a non-coincidence among all participants in terms of prior­itization of potential cardiotocographic indices of foetal non-wellness. Our study confirmed that the interpretation of the CTG pattern is highly subjective, irrespective of the guideline adopted, and CTG-misinterpre­tation represents the major determinant for increased frequency of ob­stetrical intervention during labour.
Conclusions. A difference in the interpretation of CTG-tracks exists, has been described in the literature and highlighted by our study. Advanced continuous training on the interpretation of CTG in labour, cases audit and debriefing, involving all the team, is certainly the best method to implement the knowledge of foetal heart rate tracing interpretation and to standardize the labour and delivery management.