# Electronic fetal heart-rate monitoring (cardiotocography) Technology · id `maternal:electronic-fetal-monitoring` · Maternal & Newborn Atlas · release `c7fb95f1d15a7d13` (public) > General information from published sources, not medical advice, and not reviewed by clinicians. Check the cited source before relying on anything here. The atlas's own text and curation may be reused under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0, https://creativecommons.org/licenses/by-nc/4.0/): credit the atlas, and do not use it commercially. See the atlas About page. Text quoted from a source stays under that source's own terms, given as the source's reuse\_basis. The atlas's reuse terms do not cover it. The downloads list each quotation with its source in third\_party\_quotations. Browse, life stage: Pregnancy; Childbirth Browse, care area: The baby before birth ## In plain language A recording of the baby's heart rate and the mother's contractions, usually through belts on the abdomen. It is used to spot babies who may be short of oxygen. A Cochrane review found that, compared with listening intermittently, continuous recording during labour halved newborn seizures, did not clearly change deaths around birth, and was linked with more caesarean and instrumental births. ## Technical summary Cardiotocography (CTG) records changes in the fetal heart rate and their relation to uterine contractions, to guide further assessment or decide on caesarean or instrumental birth (Cochrane review background). The Cochrane review (PMID 28157275; 13 trials, over 37,000 women, searched to November 2016) compared continuous CTG with intermittent auscultation; the evidence is mostly low quality. Two US-cleared wireless products (Novii patch and INVU) are filed under it. A link to the labour page awaits that cluster's record. ## Claims, with the population each applies to ## Context: Fetuses and babies of women in labour, continuous cardiotocography against intermittent auscultation (Cochrane review) Recipient: Mixed recipients; Population: Fetuses and babies of women in labour in 13 randomised and quasi-randomised trials involving over 37,000 women. One trial of 4044 women compared continuous cardiotocography with intermittent cardiotocography; the other 12 trials compared it with intermittent auscultation. The abstract does not describe the women beyond subgroups for low risk, high risk and preterm pregnancy. Outcomes in this context (perinatal death, neonatal seizures, cerebral palsy) are counted in babies.; Care setting: Labour in the included trials; setting not described in the abstract; Geography: Not stated in the abstract; Life stage: Labour; follow-up to the newborn period and, for cerebral palsy, later childhood; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not stated in the parts of the source that were read. ### A Cochrane review of 13 trials involving over 37,000 women compared continuous cardiotocography during labour with intermittent auscultation (one trial of 4044 women compared it with intermittent cardiotocography). Continuous cardiotocography was associated with halving of neonatal seizure rates (risk ratio 0.50, 95% CI 0.31 to 0.80; 9 trials, N = 32,386). The review authors graded this evidence moderate. - Category: Effect - Evidence stage: Evidence synthesis - Certainty: Moderate certainty (method: Cochrane review authors' own GRADE assessment for the neonatal seizure outcome, as stated in the abstract (moderate)) - Applies to: Recipient: Mixed recipients; Population: Fetuses and babies of women in labour in 13 randomised and quasi-randomised trials involving over 37,000 women. One trial of 4044 women compared continuous cardiotocography with intermittent cardiotocography; the other 12 trials compared it with intermittent auscultation. The abstract does not describe the women beyond subgroups for low risk, high risk and preterm pregnancy. Outcomes in this context (perinatal death, neonatal seizures, cerebral palsy) are counted in babies.; Care setting: Labour in the included trials; setting not described in the abstract; Geography: Not stated in the abstract; Life stage: Labour; follow-up to the newborn period and, for cerebral palsy, later childhood; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not stated in the parts of the source that were read. - Limitations: Methodological quality was mixed, all included studies were at high risk of performance bias, and only two trials were assessed as high quality. No data were found comparing no fetal monitoring with continuous cardiotocography. The comparison is with intermittent auscultation, not with no monitoring. Only the abstract was read. - Last checked: 2026-10-14 - Sources: 1. Supports: Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read.) Locator: Abstract, BACKGROUND, sentence 1. Retrieved 2026-10-14T18:18:38Z. Source state: Current. Snapshot hash: d0085333edd256687e4fc9230a365c34f7e33f5f2f90ef9979bf612708c9a3cd. How it applies: PubMed abstract. 2. Supports: Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read.) Locator: Abstract, MAIN RESULTS, sentence 1. Retrieved 2026-10-14T18:18:38Z. Source state: Current. Snapshot hash: d0085333edd256687e4fc9230a365c34f7e33f5f2f90ef9979bf612708c9a3cd. How it applies: PubMed abstract. 3. Supports: Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read.) Locator: Abstract, MAIN RESULTS, sentence 2, fragment 1 of 2. Retrieved 2026-10-14T18:18:38Z. Source state: Current. Snapshot hash: d0085333edd256687e4fc9230a365c34f7e33f5f2f90ef9979bf612708c9a3cd. How it applies: PubMed abstract. 4. Supports: Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read.) Locator: Abstract, MAIN RESULTS, sentence 2, fragment 2 of 2. Retrieved 2026-10-14T18:18:38Z. Source state: Current. Snapshot hash: d0085333edd256687e4fc9230a365c34f7e33f5f2f90ef9979bf612708c9a3cd. How it applies: PubMed abstract. 5. Supports: Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read.) Locator: Abstract, MAIN RESULTS, sentence 3. Retrieved 2026-10-14T18:18:38Z. Source state: Current. Snapshot hash: d0085333edd256687e4fc9230a365c34f7e33f5f2f90ef9979bf612708c9a3cd. How it applies: PubMed abstract. 6. Supports: Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read.) Locator: Abstract, MAIN RESULTS, sentence 4. Retrieved 2026-10-14T18:18:38Z. Source state: Current. Snapshot hash: d0085333edd256687e4fc9230a365c34f7e33f5f2f90ef9979bf612708c9a3cd. How it applies: PubMed abstract. 7. Supports: Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read.) Locator: Abstract, MAIN RESULTS, sentence 5. Retrieved 2026-10-14T18:18:38Z. Source state: Current. Snapshot hash: d0085333edd256687e4fc9230a365c34f7e33f5f2f90ef9979bf612708c9a3cd. How it applies: PubMed abstract. 8. Supports: Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read.) Locator: Abstract, MAIN RESULTS, sentence 6, fragment 1 of 4. Retrieved 2026-10-14T18:18:38Z. Source state: Current. Snapshot hash: d0085333edd256687e4fc9230a365c34f7e33f5f2f90ef9979bf612708c9a3cd. How it applies: PubMed abstract. 9. Supports: Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read.) Locator: Abstract, MAIN RESULTS, sentence 6, fragment 3 of 4. Retrieved 2026-10-14T18:18:38Z. Source state: Current. Snapshot hash: d0085333edd256687e4fc9230a365c34f7e33f5f2f90ef9979bf612708c9a3cd. How it applies: PubMed abstract. 10. Supports: Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read.) Locator: Abstract, MAIN RESULTS, sentence 6, fragment 4 of 4. Retrieved 2026-10-14T18:18:38Z. Source state: Current. Snapshot hash: d0085333edd256687e4fc9230a365c34f7e33f5f2f90ef9979bf612708c9a3cd. How it applies: PubMed abstract. ### In the same Cochrane review, continuous cardiotocography showed no significant improvement in the overall perinatal death rate compared with intermittent auscultation (risk ratio 0.86, 95% CI 0.59 to 1.23; 11 trials, N = 33,513). There was no difference in cerebral palsy rates (risk ratio 1.75, 95% CI 0.84 to 3.63; 2 trials, N = 13,252). The review authors graded both low. - Category: Effect - Evidence stage: Evidence synthesis - Certainty: Low certainty (method: Cochrane review authors' own GRADE assessment for the perinatal death and cerebral palsy outcomes, as stated in the abstract (low)) - Applies to: Recipient: Mixed recipients; Population: Fetuses and babies of women in labour in 13 randomised and quasi-randomised trials involving over 37,000 women. One trial of 4044 women compared continuous cardiotocography with intermittent cardiotocography; the other 12 trials compared it with intermittent auscultation. The abstract does not describe the women beyond subgroups for low risk, high risk and preterm pregnancy. Outcomes in this context (perinatal death, neonatal seizures, cerebral palsy) are counted in babies.; Care setting: Labour in the included trials; setting not described in the abstract; Geography: Not stated in the abstract; Life stage: Labour; follow-up to the newborn period and, for cerebral palsy, later childhood; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not stated in the parts of the source that were read. - Limitations: The cerebral palsy interval is wide (0.84 to 3.63) and does not rule out an increase or a decrease. All included studies were at high risk of performance bias. Only the abstract was read. - Last checked: 2026-10-14 - Sources: 1. Supports: Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read.) Locator: Abstract, MAIN RESULTS, sentence 5. Retrieved 2026-10-14T18:18:38Z. Source state: Current. Snapshot hash: d0085333edd256687e4fc9230a365c34f7e33f5f2f90ef9979bf612708c9a3cd. How it applies: PubMed abstract. 2. Supports: Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read.) Locator: Abstract, MAIN RESULTS, sentence 6, fragment 1 of 4. Retrieved 2026-10-14T18:18:38Z. Source state: Current. Snapshot hash: d0085333edd256687e4fc9230a365c34f7e33f5f2f90ef9979bf612708c9a3cd. How it applies: PubMed abstract. 3. Supports: Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read.) Locator: Abstract, MAIN RESULTS, sentence 6, fragment 2 of 4. Retrieved 2026-10-14T18:18:38Z. Source state: Current. Snapshot hash: d0085333edd256687e4fc9230a365c34f7e33f5f2f90ef9979bf612708c9a3cd. How it applies: PubMed abstract. 4. Supports: Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read.) Locator: Abstract, MAIN RESULTS, sentence 6, fragment 3 of 4. Retrieved 2026-10-14T18:18:38Z. Source state: Current. Snapshot hash: d0085333edd256687e4fc9230a365c34f7e33f5f2f90ef9979bf612708c9a3cd. How it applies: PubMed abstract. 5. Supports: Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read.) Locator: Abstract, MAIN RESULTS, sentence 7. Retrieved 2026-10-14T18:18:38Z. Source state: Current. Snapshot hash: d0085333edd256687e4fc9230a365c34f7e33f5f2f90ef9979bf612708c9a3cd. How it applies: PubMed abstract. ## Context: Women in labour, continuous cardiotocography against intermittent auscultation (Cochrane review) Recipient: Maternal; Population: Women in labour in the same 13 trials. Outcomes in this context (caesarean section, instrumental vaginal birth) are counted in women.; Care setting: Labour in the included trials; setting not described in the abstract; Geography: Not stated in the abstract; Life stage: Labour and birth; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not stated in the parts of the source that were read. ### In the Cochrane review, continuous cardiotocography was associated with more caesarean sections than intermittent auscultation (risk ratio 1.63, 95% CI 1.29 to 2.07; 11 trials, N = 18,861) and women were also more likely to have instrumental vaginal births (risk ratio 1.15, 95% CI 1.01 to 1.33; 10 trials, N = 18,615). The review authors graded both low. In the single trial comparing continuous with intermittent cardiotocography, there was no difference in caesarean section rates (risk ratio 1.29, 95% CI 0.84 to 1.97; 4044 women). - Category: Safety - Evidence stage: Evidence synthesis - Certainty: Low certainty (method: Cochrane review authors' own GRADE assessment for the caesarean section and instrumental vaginal birth outcomes, as stated in the abstract (low)) - Applies to: Recipient: Maternal; Population: Women in labour in the same 13 trials. Outcomes in this context (caesarean section, instrumental vaginal birth) are counted in women.; Care setting: Labour in the included trials; setting not described in the abstract; Geography: Not stated in the abstract; Life stage: Labour and birth; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not stated in the parts of the source that were read. - Limitations: These are harms counted in women. The evidence is low quality, and all included studies were at high risk of performance bias. The abstract does not say whether the extra operative births were clinically needed. Only the abstract was read. - Last checked: 2026-10-14 - Sources: 1. Supports: Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read.) Locator: Abstract, MAIN RESULTS, sentence 5. Retrieved 2026-10-14T18:18:38Z. Source state: Current. Snapshot hash: d0085333edd256687e4fc9230a365c34f7e33f5f2f90ef9979bf612708c9a3cd. How it applies: PubMed abstract. 2. Supports: Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read.) Locator: Abstract, MAIN RESULTS, sentence 8, fragment 1 of 2. Retrieved 2026-10-14T18:18:38Z. Source state: Current. Snapshot hash: d0085333edd256687e4fc9230a365c34f7e33f5f2f90ef9979bf612708c9a3cd. How it applies: PubMed abstract. 3. Supports: Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read.) Locator: Abstract, MAIN RESULTS, sentence 8, fragment 2 of 2. Retrieved 2026-10-14T18:18:38Z. Source state: Current. Snapshot hash: d0085333edd256687e4fc9230a365c34f7e33f5f2f90ef9979bf612708c9a3cd. How it applies: PubMed abstract. 4. Supports: Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read.) Locator: Abstract, MAIN RESULTS, sentence 9, fragment 1 of 2. Retrieved 2026-10-14T18:18:38Z. Source state: Current. Snapshot hash: d0085333edd256687e4fc9230a365c34f7e33f5f2f90ef9979bf612708c9a3cd. How it applies: PubMed abstract. 5. Supports: Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read.) Locator: Abstract, MAIN RESULTS, sentence 9, fragment 2 of 2. Retrieved 2026-10-14T18:18:38Z. Source state: Current. Snapshot hash: d0085333edd256687e4fc9230a365c34f7e33f5f2f90ef9979bf612708c9a3cd. How it applies: PubMed abstract. 6. Supports: Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read.) Locator: Abstract, MAIN RESULTS, sentence 10, fragment 3 of 4. Retrieved 2026-10-14T18:18:38Z. Source state: Current. Snapshot hash: d0085333edd256687e4fc9230a365c34f7e33f5f2f90ef9979bf612708c9a3cd. How it applies: PubMed abstract. 7. Supports: Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read.) Locator: Abstract, MAIN RESULTS, sentence 10, fragment 4 of 4. Retrieved 2026-10-14T18:18:38Z. Source state: Current. Snapshot hash: d0085333edd256687e4fc9230a365c34f7e33f5f2f90ef9979bf612708c9a3cd. How it applies: PubMed abstract. ## Connected pages - Fetal heart-rate monitoring: Fetal development (`maternal:fetal-development`) - The labour and birth page: Labour and birth (`maternal:labour-and-birth`) - Filed under this front: Imaging and monitoring (`maternal:front-imaging-and-monitoring`) - Used by: INVU by Nuvo (maternal-fetal monitoring belt) (`maternal:invu-remote-monitoring`) - Used by: Novii wireless patch system (fetal heart rate from the abdomen) (`maternal:novii-wireless-patch`) - Investigated in: TRUFFLE trial (timing of birth in early fetal growth restriction) (`maternal:truffle-trial`) ## Provenance Content hash: 0f4bc40de3ed5dd750e3eb3422c94857a2a3d60e5f255d9fdf955aa55c225a0a Last substantive edit: 2026-10-14 Evidence last checked: 2026-10-14