Objectives To assess the effectiveness of an intrapartum CTG interpretation tool.

Background Intrapartum electronic fetal monitoring is used as a method of evaluating fetal well-being in labour. NICE guidance on the classification of intrapartum CTG’s includes definitions and descriptions of individual fetal heart rate features and an overall grading system.

To improve documentation and reduce unnecessary interventions, a regional CTG evaluation tool (sticker) was introduced summarising this guidance.

Method Retrospective review of 101 intrapartum CTG stickers from 24 patient charts assessing standard of documentation and accuracy of CTG classification.

Results All 4 features were assessed and assigned an overall grading in 82/101 (81%) of cases, of which 74/82 (90%) were concordant with independent analysis of overall grading. The CTG was upgraded from normal to suspicious in 3/82 (4%) cases and downgraded from suspicious to normal in 5/82 (6%) cases.

Original FHR documentation was incomplete in 19/101 (19%) cases of which 8/19 (42%) were independently graded as suspicious.

Conclusions There was suboptimal completion of CTG stickers as only 81% (82/101) had all 4 features assessed and were assigned an overall grading.

In cases where the CTG stickers were fully completed, 91% (75/82) were independently graded as normal. Whereas, when the features were incomplete, 42% (8/19) were graded as suspicious following independent analysis which seemed to indicate a difficulty with interpretation and categorisation of decelerations and a reluctance of staff to commit to an overall grading if the CTG was not normal.