Does CTG monitoring reduce perinatal mortality in ‘high risk’ women?

Does electronic fetal heart rate or CTG monitoring reduce perinatal mortality in ‘high risk’ women?

You may have already seen me chatting about this, an important study that I featured in a recent Birth Information Update. It’s such a useful and interesting paper that I’m going to share it again, for the benefit of anyone who hasn’t yet come across it or would like more information.


CTGs: what do we know?

There are three things we currently know about when it comes to CTG monitoring in labour.

1. CTG monitoring doesn’t prevent perinatal death or cerebral palsy when it is used in healthy (“low risk”) labouring women.

2. CTG monitoring does increase the chance of caesarean and other interventions.

3. Despite both of these things being well grounded in robust evidence, the use of CTG monitoring is widespread.

We have long needed more evidence about the effect of CTG monitoring in women who are deemed to be at higher risk for a poor perinatal outcome. And so I was delighted to see the publication of a systematic literature review and meta-analysis which looked at this very question. That is, whether cardiotocograph monitoring rather than intermittent auscultation during labour was associated with changes in perinatal mortality or cerebral palsy rates for high-risk women.

CTG in higher risk women

Small et al (2019) looked at nine RCTs and 26 non-experimental studies. Here’s what they found … the bold emphasis is mine:

“Meta-analysis of pooled data from RCTs in mixed- and high-risk populations found no statistically significant differences in perinatal mortality rates. The majority of non-experimental research was at critical risk of bias and should not be relied on to inform practice. Cardiotocograph monitoring during preterm labour was associated with a higher incidence of cerebral palsy.”

They conclude that, “Research evidence failed to demonstrate perinatal benefits from intrapartum cardiotocograph monitoring for women at risk for poor perinatal outcome. There is an urgent need for well-designed research to consider whether intrapartum cardiotocograph monitoring provides benefits.”


What’s happening here?

Why is CTG monitoring in preterm labour associated with a higher incidence of cerebral palsy? We don’t know. And until more people greet findings like these with openness and curiosity rather than defensiveness, we won’t find out.

As more than one person said when we were chatting about this paper on social media, it is always amazing to note how much intervention and interference in pregnancy and birth is introduced without much evidence to support it. And yet it takes a phenomenal amount of research to even begin to dismantle and discontinue practices that aren’t helpful and may be harmful. And we’re nowhere near there yet with electronic fetal monitoring. But every paper like this is another that we can discuss with colleagues, women and families, in the hope of moving to care that is more respectful, woman-centred and evidence-based.


Small KA et al (2019). Intrapartum cardiotocograph monitoring and perinatal outcomes for women at risk: Literature review. Women and Birth

You can see the full text of the research at


Would you like to see more fetal monitoring research resources?

Fetal monitoring research resources


If you’d like to stay up-to-date with birth-related research and thinking, make sure you’re subscribed to our free newsletter list, which means you’ll get Sara’s monthly Birth Information Update.
And if you’re a midwife or other birth worker who enjoys unpacking research, seeing what’s behind the headlines and sharing wisdom with like-minded others, come and join Sara and colleagues from all over the world in one of our online courses!