Electronic intrapartum fetal monitoring. A systematic review of international clinical practice guidelines.

Abstract Objective Electronic fetal monitoring (EFM) or fetal assessment by a cardiotocograph (CTG) is currently the most commonly employed tool for intrapartum surveillance. There are numerous guidelines that inform best practice across the world. The systematic review aims to compare and appraise all the available practice guidelines on intrapartum EFM to describe the similarities and variations in recommendations. Study design A systematic protocol was developed as per PRISMA-P (Preferred Reporting Item for Systematic Review and Meta-Analysis). Four independent reviewers were involved with independent searches and quality assessment using the appraisal of guidelines for research and evaluation (AGREE II) instrument for guideline quality reporting. Results Seven international practice guidelines are included in this systematic review. AGREE II showed higher scores for scope & purpose and for clarity of presentation, however the overall assessment varied between 25% and 89%. When individual characteristics of EFM/CTG are compared, all guidelines and guidance are essentially trying to describe the characters similarly, with some very important differences as described in the full article. Conclusion In the context of globalization, a uniform approach for defining terminology, classifying characters and similar interpretation of results is needed for electronic fetal monitoring. We should therefore consider a unified, simple, logistically approved and acceptable guideline, which is likely to be accepted across the world.