Fetal monitoring in labour

Context

This guideline covers the care of healthy women who go into labour at term. Of the 625,000 live births in England and Wales in 2021, approximately 90% were single babies born at term (37+0 weeks onwards), and so the recommendations in this guideline will affect over half a million women every year.

Wherever birth happens (at home, in a midwifery-led unit or in an obstetric unit) monitoring the wellbeing of the woman and baby during labour is an important part of intrapartum care. The recommendations in this guideline cover fetal assessment and monitoring, including intermittent auscultation and cardiotocography. Risk assessment to determine the most appropriate method of monitoring is covered, as well as the interpretation of cardiotocograph traces, and escalation when fetal hypoxia is suspected.

This guideline replaces the fetal monitoring section in the NICE guideline on intrapartum care. Editorial changes have been made to highlight the need for continual risk assessment of the woman and the baby in labour and to simplify the interpretation and categorisation of the cardiotocography (CTG) trace. The new guidance highlights that a change in the categorisation of the CTG is an intrapartum risk factor but equally important are the development of other intrapartum risk factors such as sepsis, slow progress, the presence of meconium and uterine tachysystole, all of which are associated with a poor outcome for the baby. There is a recognition that contraction frequency needs to be carefully monitored and the presence of 5 or more contractions in 10 minutes needs action. The updated guidance also reminds healthcare professionals that intravenous fluids should not be used as part of the management of an abnormal CTG unless the woman is hypotensive, and that the guideline is only applicable to the categorisation of intrapartum CTGs. The evidence on fetal blood sampling has been reviewed for this update and the recommendations updated based on recent evidence.