Cardiotocography: A Review of Its Efficacy in Low-Risk Pregnancies

Saturday, 28 October 2017

Stephanie N. Limbers
Christelyn G. Jesson, SN
School of Nursing, Cedarville University, Cedarville, OH, USA

Cardiotocography was introduced in the late 1960s to reduce poor perinatal outcomes, yet its efficacy is questionable at best. While cardiotocography is used in 85% of American births, women often do not realize that, in low-risk labors, intermittent auscultation is a valid and safe alternative. Today, Cesarean section rates in the United States are at an unsurpassed high (33%), which warrants efforts to reduce its incidence. Few seem to realize the implications related to these surgical interventions, which range from physical to financial outcomes.

In order to explore cardiotocography as a possible risk factor for Cesarean deliveries, an integrative literature review was conducted. This study examines both maternal and fetal outcomes related to the two existing types of fetal heart rate monitoring: cardiotocography and intermittent auscultation. To compile current literature, several medical databases were searched, as well as professional sources. After inclusion and exclusion criteria were applied, eleven sources proved integral to the synthesis of evidence. Studies originated from a wide geographical spread, including the United States, Greece, Ireland, India, Iran, England, the United Kingdom, and Canada. All the women included in these research studies were classified as low-risk labors at the time of admission to the labor ward. Methods varied among the type of electronic fetal heart rate monitoring used, whether simply an admission test or continuous throughout the labor process. Intermittent auscultation guidelines were followed, allowing practitioners frequent and watchful assessment, similar to that of cardiotocography. However, with intermittent auscultation, members of the health care team may provide hands-on care for the laboring mother, while continuous electronic monitoring requires less practitioner-patient contact.

Findings revealed that cardiotocography increases a low-risk mother’s chance to deliver via Cesarean section or instrumental vaginal delivery. By contrast, Apgar scores, neonatal cerebral palsy rates, and perinatal mortality rates did not vary based on the use of cardiotocography compared to intermittent auscultation. Finally, perinatal seizure rates were reduced with the use of cardiotocography. Thus, with the use of cardiotocography, outcomes for mothers have changed in a negative way, while outcomes for neonates have remained unchanged since cardiotocography’s inception. This synthesis of the current literature suggests that practice should be updated; nurses need to be educators and advocates for the use of intermittent auscultation with the appropriate patient population, a practice not currently employed. While cardiotocography is often used for convenience or liability, nurses must strive to uphold a high standard of evidence-based care, which will produce more favorable, patient-centered outcomes.