Quality standard

Quality statement 4: Stopping cardiotocography

Quality statement 4: Stopping cardiotocography

Quality statement

Women at low risk of complications who have cardiotocography because of concern arising from intermittent auscultation have the cardiotocograph removed if the trace is normal for 20 minutes.

Rationale

Cardiotocography is offered to women if intermittent auscultation indicates possible fetal heart rate abnormalities. However, cardiotocography that is started for this reason should be stopped if the trace is normal for 20 minutes, because it restricts the woman's movement and can cause labour to slow down. This can lead to a cascade of interventions that may result in adverse birth outcomes.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that women at low risk of complications having cardiotocography because of concern arising from intermittent auscultation have the cardiotocograph removed if the trace is normal for 20 minutes.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from local protocols on cardiotocography.

Process

Proportion of women at low risk of complications who receive cardiotocography because of concern arising from intermittent auscultation who have the cardiotocograph removed if the trace is normal for 20 minutes.

Numerator – the number in the denominator who have the cardiotocograph removed.

Denominator – the number of women in labour at low risk of complications who receive cardiotocography because of concern arising from intermittent auscultation who have a normal trace for 20 minutes.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

Outcome

Maternal satisfaction and experience of care.

Data source: National data is collected as part of the Care Quality Commission's Maternity Survey, section C ('Your labour and the birth of your baby'). Data can also be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient satisfaction surveys.

What the quality statement means for different audiences

Service providers (freestanding midwifery units, alongside midwifery units and obstetric units) have evidence of local arrangements to ensure that protocols are in place so that women in labour at low risk of complications who have cardiotocography because of concern arising from intermittent auscultation have the cardiotocograph removed if the trace is normal for 20 minutes.

Healthcare professionals (midwives and obstetricians) remove the cardiotocograph if the trace is normal for 20 minutes for women at low risk of complications who have cardiotocography because of concern arising from intermittent auscultation.

Commissioners (integrated care systems) specify and check that service providers have protocols in place to ensure that women in labour at low risk of complications who have cardiotocography because of concern arising from intermittent auscultation have the cardiotocograph removed if the trace is normal for 20 minutes.

Women who are at low risk of problems during labour, but who have electronic monitoring because of possible concerns about the baby's heartbeat, are taken off the monitor if the baby's heartbeat is normal for 20 minutes.

Source guidance

Fetal monitoring in labour. NICE guideline NG229 (2022), recommendations 1.2.12 to 1.2.14

Definitions of terms used in this quality statement

Normal cardiotocograph trace

A normal trace has the following normal/reassuring features:

  • baseline fetal rate of 110 to 160 beats per minute and

  • baseline variability of 5 to 25 beats per minute and

  • no or early decelerations or variable decelerations that are not evolving to have concerning characteristics.

[NICE's guideline on fetal monitoring in labour, recommendations 1.4.15, 1.4.18 and 1.4.24]