Reliability in cardiotocography interpretation – impact of extended on‐site education in addition to web‐based learning: an observational study

Gyllencreutz, Erika; Varli, Ingela Hulthén; Lindqvist, Pelle G.; Holzmann, Malin

doi:10.1111/aogs.13090

Cited by 17 publications

(12 citation statements)

References 33 publications

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“…We identified 64 studies that met our inclusion criteria (Figure 1 ) reported across 65 papers (two papers reported different outcomes from the same study). 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , …”

Section: Resultsmentioning

confidence: 99%

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Training in the use of intrapartum electronic fetal monitoring with cardiotocography: systematic review and meta‐analysis

Kelly

Redmond

King

et al. 2021

BJOG

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Background Sub-optimal classification, interpretation and response to intrapartum electronic fetal monitoring using cardiotocography are known problems. Training is often recommended as a solution, but there is lack of clarity about the effects of training and which type of training works best.Objectives Systematic review of the effects of training healthcare professionals in intrapartum cardiotocography (PROSPERO protocol: CRD42017064525).

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Section: Resultsmentioning

confidence: 99%

“…45,62,63,71,73 The actual numbers participating in each of the studies were often not reported or were unclear. 26,41,44,45,49,50,53,60,[62][63][64][69][70][71][72][73][74]77,78,84 Where participant numbers were reported, they varied from six 51,75 to 4439 81 individuals.…”

Section: Participantsmentioning

confidence: 99%

Training in the use of intrapartum electronic fetal monitoring with cardiotocography: systematic review and meta‐analysis

Kelly

Redmond

King

et al. 2021

BJOG

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“…Several reports are available on the content of CTG training programs and many publications regarding the impact of CTG education programs on professionals' skills [11,18,19,20]. However, we were unable to identify any published studies regarding the development of validated CTG tools measuring knowledge of midwives and obstetricians regarding the EFM.…”

Section: Introductionmentioning

confidence: 96%

The development and psychometric evaluation of the Electronic Fetal Monitoring Knowledge Scale

Gourounti

Sarantaki

Diamanti

et al. 2020

Preprint

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Background. The aim of this study was to develop and assess the psychometric properties of the Electronic Fetal Monitoring Knowledge Scale (EFMKS), a self-report and short instrument measuring knowledge concerning Electronic Fetal Monitoring (EFM). Additionally, it was aimed to use the EFMKS for briefly assessing EFM knowledge in midwives and doctors working in labour ward. Methods. The EFMKS was developed in a three-phase process by using an integrated mixed-methods approach that included literature reviews, professional focus groups, expert consultations and a psychometric survey evaluation. The psychometric evaluation was conducted by recruiting a sample of 128 professionals (midwives and doctors). Data were collected between April and July of 2016 in two public hospitals of Athens, Greece. Content validity, exploratory factor analysis, discriminant and construct validity, test-retest reliability and internal consistency were explored. Results. The expert panel determined that the content validity was satisfactory. The final 10-item scale consisted of three factors explaining 73% of the total variance in the data. Discriminant validity was satisfactory. Internal consistency reliability (α = 0.89) and test-retest reliability (0.85) were satisfactory. The majority of the midwives and the obstetricians had a good level of knowledge while approximately one third of them had a low level of knowledge in EFM. Midwives and doctors having a lower level of knowledge related to EFM, were more frequently professionals with less than five years of clinical experience in the labor ward and reported low confidence for cardiotocography (CTG) interpretation and inadequate preparation for CTG usage.Conclusion. The EFMK demonstrated good content validity, an easily interpretable three-factor structure, high internal consistency, high test-retest reliability, and satisfactory discriminant and construct validity with sample characteristics. The EFMKS may be used for evaluating the EFM knowledge of health professionals and for identifying the areas of their knowledge gap. Based on study findings, an annual multi-professional CTG training is necessary for all intrapartum staff and in particular for the midwives and doctors with shorter clinical experience in the labor ward.

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“…Cardiotocograph (CTG) trace was introduced into clinical practice in 1960s to recognise intrapartum fetal hypoxic stress, so that timely action could be taken to avoid hypoxic ischaemic encephalopathy (HIE) and its long-term sequelae such as cerebral palsy and learning difficulties, and/or perinatal deaths. Unfortunately, CTG trace was introduced into clinical practice without any robust randomised controlled trials, and therefore, it not only resulted in significant inter and intra-observer variability [1,2], it also contributed to confusion with regard to appropriate response to the observed CTG changes. Fetal pathophysiological responses to hypoxic and mechanical stresses were not well understood, and well-meaning midwives and obstetricians were coerced to use the CTG which was introduced into clinical practice without robust scientific evidence to confirm its effectiveness [3].…”

Section: Introductionmentioning

confidence: 99%

Maternal “Oxygen and Fluids Therapy” to Correct Abnormalities in the Cardiotocograph (CTG): Scientific Principles vs Historical (Mal) Practices

Chandraharan

2020

JAMMR

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Some Guidelines on Cardiotocograph (CTG) trace continue to recommend the administration of oxygen and fluids to the mother to correct the abnormalities observed on the cardiotocograph. However, the fetus has a separate autonomic nervous system, blood volume, haemoglobin concentration, oxygen saturation and cardiovascular responses as compared to the mother. Therefore, administration of oxygen and fluids to the mother to correct observed “suspicious” CTG traces should be questioned in contemporary obstetric practice. This commentary examines the scientific principles and current scientific evidence on these historical practices, and all practising midwives and obstetricians should urgently review their individual clinical practice, based on the knowledge of anatomy, physiology and biochemistry as well as a critical review of current scientific evidence to prevent avoidable patient harm. Current evidence suggests that administration of oxygen to the mother, who has a normal oxygen saturation does not correct the observed abnormalities on the CTG trace, and it may in fact lead to harm. Similarly, administration of fluids (oral or intravenous) to a woman during labour who is not dehydrated or hypotensive may not only cause maternal dilutional hyponatremia and resultant complications, but also, it may cause neonatal convulsions. Women and babies expect every healthcare provider to practice evidence-based medicine during the intrapartum period, which is based on logic, common sense and robust scientific principles, irrespective of what is erroneously stated by some CTG guidelines.

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Reliability in cardiotocography interpretation – impact of extended on‐site education in addition to web‐based learning: an observational study

Cited by 17 publications

References 33 publications

Training in the use of intrapartum electronic fetal monitoring with cardiotocography: systematic review and meta‐analysis

Training in the use of intrapartum electronic fetal monitoring with cardiotocography: systematic review and meta‐analysis

The development and psychometric evaluation of the Electronic Fetal Monitoring Knowledge Scale

Maternal “Oxygen and Fluids Therapy” to Correct Abnormalities in the Cardiotocograph (CTG): Scientific Principles vs Historical (Mal) Practices

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