Two recent studies conclude that current CTG guidelines are insufficient when it comes to detection of fetal acidosis

The purpose of fetal monitoring is to detect early signs of fetal hypoxia, enabling interventions to prevent the development of asphyxia. In 2015, the International Federation of Gynaecology and Obstetrics (FIGO) presented a new set of guidelines for CTG interpretation and clinical management called FIGO-15. In Sweden, these were modified into a national set of guidelines called SWE-17, which replaced the previous guidelines, designated SWE-09. The performance of the guidelines had not, however, been scientifically evaluated before their clinical implementation.

The two studies by Ekengård et al. aimed to evaluate the diagnostic validity of the three sets of guidelines in terms of sensitivity and specificity in the detection of fetal acidosis during the first and second stages of labour. The results of the studies indicate that the ability of the current guidelines to detect fetal acidosis is insufficient and that there is a need for improved interpretation protocols. According to the authors, many clinical factors other than the CTG pattern are important for decision making, including a physiological understanding of fetal heart rate changes.

Low sensitivity of the new FIGO classification system for electronic fetal monitoring to identify fetal acidosis in the second stage of labor
Ekengård et al.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2020
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Impaired validity of the new FIGO and Swedish CTG classification templates to identify fetal acidosis in the first stage of labor
Ekengård et al.
The Journal of Maternal-Fetal & Neonatal Medicine, 2020
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