{
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  "owner": "maternal",
  "kind": "technology",
  "slug": "electronic-fetal-monitoring",
  "name": "Electronic fetal heart-rate monitoring (cardiotocography)",
  "aliases": [],
  "atlases": [
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  "summary_plain": "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.",
  "summary_technical": "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.",
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    "strengths": [
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      "Continuous CTG showed no significant improvement in overall perinatal death and was associated with more caesarean sections and instrumental vaginal births (low-quality evidence).",
      "All included studies were at high risk of performance bias, and no data compared no monitoring with continuous CTG."
    ],
    "required_infrastructure": [
      "A cardiotocograph monitor, or a wireless patch (Novii) that can feed one, within its cleared population: women in labour at more than 36 completed weeks with a singleton pregnancy for Novii, and singleton pregnancies at 34 weeks 0/7 days or later for Novii+; and staff able to read the trace."
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      "statement": "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).",
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        "geography": "Not stated in the abstract",
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      "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.",
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      "statement": "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.",
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