Rationalising use of Cardiotocography (CTG) in India for evidence based decision making during labour

• Beena Joshi,*  
• Asim Kumar Padhan,  
• Nitin Ambadekar

Abstract

Out of the 2.62 million stillbirths globally in 2015, India unacceptably tops the list with a contribution of about 592,000 stillbirths and Foetal monitoring during labour is a crucial practice for identifying potential foetal distress and improving perinatal outcomes. Antepartum and intrapartum Cardiotocography (CTG) is the first line investigation for foetal assessment and it provides details about foetal heart rate such as baseline variability, accelerations and deceleration, however evidence suggests, CTG test is a simple, non-invasive screening test, not a diagnostic tool and routine CTG is not recommended for low risk pregnancies as it can increase the risk of caesarean section without evidence of benefit. There is a need to evaluate the use of CTG in public health settings in India, assess the decision making for interventions by the health care providers. Based on the evaluation, there is a need to develop standard treatment workflow or standard operating procedures (SOPs) to optimize the CTG use in Indian public health system context. Further research is needed for evaluation of newer portable smart CTG machines for its clinical and cost effectiveness to predict foetal distress.

Keywords

Cardiotocography (CTG),Fetal monitoring,Fetal distress,Perinatal mortality,Antepartum CTG,Intrapartum CTG,Low-risk pregnancy,High-risk pregnancy,Uterine contractions,Intermittent auscultation