Isa Mushtaq

_ In clinical practice the fetal CTG continues to be a source of problems, both in interpretation and in what degree of action should be taken: This is particularly the case for antenatal (non labour) CTG's since there has not been the same clarification that was provided for electronic intrapartum fetal monitoring by specific NICE guidance: Currently there is no detailed national guidance on antepartum CTG assessment and therefore no guidance as to the circumstances in which CTG changes or abnormalities require urgent delivery: For example, the following problems with antenatal CTG interpretation may arise: - Should change of position or intravenous fluids be used in the same way as in labour (ii) What role can be given to iced water drinks or dietary intake to stimulate fetal changes (iii) At what stage should intervention should be made and with what urgency in the absence of decelerations_ What significance should be attached to reduced variability and what action should be taken in the absence of decelerations (v) What significance should be attached to the absence of accelerations where there is reduced variability: Reliance on the NICE guidance for intrapartum CTG monitoring to interpret antenatal CTG features is of limited value because: It is not intended for such use and therefore such practice is arguably not evidence based (ii) It is much more common for fetal heart traces not to look normal during labour (in the region 20 -30 % outwith normal parameters) therefore the significance of such abnormal traces may not be the same in labour as compared to when identitied antenatally_ iii) Only a very small percentage of antenatal CTG's are not normal: There is no recourse to fetal blood sampling for an antenatal CTG, so that if suspicions persist about lack of fetal well-being there is no way of assessing fetal acid-base balance: St Mary's Hospital has now developed its own local guidance for the management of suspected abnormal antenatal CTG in order to mitigate risk. In the absence of uniform, detailed national guidance on antepartum CTG abnormalities St Marys hospital has implemented a procedure of early consultant involvement where there are persisting features of unusual CTG There should be a review to consider whether national guidance on antepartum CTG monitoring and interpretation where there are abnormalities or unusual features would lead to sater__evidence based management of such cases