National survey of routines for intrapartum fetal monitoring in Norway

Abstract

Abbreviations: CTG, cardiotocography; FBS, fetal scalp blood sampling; STAN, ST waveform analysis of fetal electrocardiogram. Abstract Introduction: This study describes clinical routines for intrapartum fetal monitoring in Norway and compliance with national clinical recommendations. Material and methods: A national survey of all (n = 48) birth units in Norway, using a self-reporting questionnaire about fetal monitoring methods and devices available in the birth units, admission cardiotocography (CTG) use, intrapartum fetal monitoring methods for women with and without risk factors, the availability of fetal scalp blood sampling facilities, and umbilical cord blood sampling routines. Results: All birth units responded. They all had access to Pinard stethoscopes, handheld Doppler devices, and CTG. Half of the units used ST waveform analysis (STAN) as an adjunct to CTG. Furthermore, 23 of 48 units analyzed fetal blood samples and 43 of 48 umbilical cord blood gas samples. In 11 units, admission CTG was routinely offered to all women. No units used continuous CTG during labor in low-risk women. However, three units routinely used intermittent CTG during the first stage of labor. Three units used CTG without having access to fetal blood samples or STAN. Conclusions: Our findings indicate some deviations from clinical recommendations in the use of intrapartum fetal monitoring in Norway. Three units used intermittent CTG for women without risk factors. Almost one in four units routinely used admission CTG, despite national clinical recommendations. The lack of access to fetal blood samples or STAN in units using CTG is of concern. K E Y W O R D S admission cardiotocography, cardiotocography, fetal scalp blood sampling, intermittent auscultation, intrapartum fetal monitoring, ST waveform analysis, umbilical cord blood gas analysis

Why don't all Norwegian birth units follow the guidelines regarding admission cardiotocography?

“…Kaasen and coworkers write that there is no evidence that admission cardiotocography (CTG) is beneficial and clinical guidelines advise against its use in low-risk women. 1 In Sweden, we see several problems with the above. First, at admission the risk status of many pregnant women is unknown, for example, in pregnancies with growth-restricted fetuses.…”

“…Kaasen et al 1 did not identify the underlying rational for continuing local use of admission CTG at 11 Norwegian birth units, contrary to national recommendations. 1 They did not provide any information on whether and how this question was evaluated. Did these units use admission CTG as the first test to assess fetal status on admission and not later intrapartum?…”

“…We have read the recently published article “National survey of routines for intrapartum fetal monitoring in Norway ” by Kaasen et al with interest, and have thoughts about both the clinical recommendations and why they are not being followed. Kaasen and coworkers write that there is no evidence that admission cardiotocography (CTG) is beneficial and clinical guidelines advise against its use in low‐risk women …”

Regarding national survey of routines for intrapartum fetal monitoring in Norway

“…We did not explore why recommendations were followed or not. We found that 11 of 48 birth units routinely used admission cardiotocograpy (CTG), despite national clinical recommendations . The Norwegian national recommendation on admission CTG is evidence‐based and states that the test should not be used in low‐risk women…”

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Sir,We thank Lindqvist and Nordström for their interest in our study. 1,2 The aim of our national survey was to describe clinical routines for intrapartum fetal monitoring and compliance with national clinical recommendations. We did not explore why recommendations were followed or not.

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