Electronic fetal monitoring

It is crucial for ST1–2 trainees to appreciate the role of electronic fetal monitoring (EFM) in pregnancy and labour, particularly its advantages and limitations. The ability to understand cardiotocograms (CTGs) is a prerequisite to being a safe and competent obstetrician, and it is important to be aware that this tool needs to be interpreted in the context of other risk factors in labour, such as meconium-stained liquor and fetal growth velocity.

Only intermittent auscultation of fetal heart rate is required for low-risk women in established labour, as indiscriminate use of continuous EFM may be associated with an increased rate of caesarean section and instrumental delivery with no corresponding decrease in cerebral palsy rate.

Failure to recognise and act on an abnormal CTG is one of the most common causes of intrapartum stillbirths and can lead to complex medicolegal issues.

Learning outcomes

When you have completed this tutorial, you will:

  • understand the scientific rationale behind the use of EFM
  • know the advantages and limitations of EFM
  • be able to interpret a CTG in the clinical context.

This tutorial was written by Miss Deepa Janga MRCOG and Mr Wai Yoong FRCOG.

Updated December 2015.