Purpose: To provide guidance on monitoring the wellbeing of the baby during labour.
Key Elements: Risk assessment, clinical assessment, interpreting findings, and methods of fetal monitoring.
Target Audience: Healthcare professionals, commissioners, maternity service providers, and pregnant women and their families.
Key Recommendations
Information and Supported Decision-Making
Discuss fetal monitoring options during antenatal care.
Document discussions and decisions in a personalized care plan.
Keep women informed about the recommended fetal monitoring method during labour.
Support women's decisions regarding fetal monitoring, including involvement of birthing companions.
Assessment During Labour and Methods for Fetal Monitoring
General Principles
Perform systematic assessments of the woman and unborn baby at least every hour.
Use fetal heart rate monitoring as a guidance tool, not standalone.
Maintain one-to-one support with a midwife throughout labour.
Initial Assessment
Conduct an initial assessment of antenatal risk factors at labour onset.
Advise women on fetal monitoring methods based on risk factors and care plan.
Explain that risk assessment is continuous and monitoring methods may change.
Intermittent Auscultation
Offer to women with low risk of complications.
Use Pinard stethoscope or Doppler ultrasound for auscultation.
Perform more frequent auscultation if fetal heart rate issues are detected.
Continuous Cardiotocography (CTG)
Do not use for antenatal CTG trace categorization.
Use CTG for intrapartum monitoring and consider maternal and fetal risk factors.
Encourage mobility and comfortable positioning for women.
Indications for Continuous Cardiotocography Monitoring in Labour
Antenatal Risk Factors
Offer continuous CTG monitoring for women with specific antenatal maternal or fetal risk factors (e.g., previous caesarean, hypertensive disorders, non-cephalic presentation).
Intrapartum Risk Factors
Be aware of intrapartum risk factors that increase fetal compromise risk and offer CTG monitoring as necessary.
Presence of Meconium
Consider meconium presence as a possible fetal compromise indicator and discuss CTG monitoring.
Use of Cardiotocography for Monitoring During Labour
Review fetal heart rate monitoring results as part of hourly risk assessments.
Assess and document contractions, baseline fetal heart rate, variability, decelerations, and accelerations.
Differentiate between maternal and fetal heartbeats regularly.
Ensure CTG trace quality and action any concerns immediately.
Making Care Decisions Based on the Cardiotocography Trace
Assess fetal wellbeing hourly and take into account all risk factors.
Support women in decision-making regarding labour management based on CTG trace interpretation.
Initiate conservative measures or expedite birth if CTG traces indicate significant concerns.
Fetal Scalp Stimulation
Consider digital fetal scalp stimulation if CTG trace is suspicious and risk factors present.
Fetal Blood Sampling
No specific recommendation due to limited evidence.
Record Keeping for Cardiotocography
Ensure accurate record keeping with correct date/time settings and clear trace labeling.
Keep CTG traces for 25 years; store electronically if possible.
Rationale and Impact
Recommendations reinforce current practice, emphasizing the importance of comprehensive clinical assessments and appropriate monitoring methods.
Context
The guideline replaces previous recommendations on fetal monitoring during labour, emphasizing risk assessment and CTG interpretation.
Updates and Changes
Editorial changes to highlight continual risk assessment and simplify CTG trace categorization.
Reviewed evidence on fetal blood sampling and made updates based on recent findings.