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.
See more of: Invited Posters