Misinterpretation of CTG by midwives is the most frequently admitted type of negligence for stillibirths. Computerised systems have much better outcomes.
A cardiotocography (CTG) machine can be used to monitor a babies heart beat in the womb. An abnormal heart rate is a strong indicator that the baby is stressed, for example because the baby has insufficient oxygen.
There is judgement involved in determining whether the CTG trace is normal or abnormal, and this can result in a delay in providing necessary interventions, or false reassurance.
Computerised decision aids, also referred to as expert systems (ESs), have a computerised knowledge base that can be matched and may be able to guide CTG interpretation to avoid such situations.
“Trials comparing computerised with conventional antenatal CTG show a strong trend towards better outcomes with the computerised assessment … Given the trial evidence, it is difficult to understand why many units still use non-computerised antenatal CTG when making these decisions.”Prof. Gordon Smith, July 2015
A tragic example
‘A woman attended the maternity unit at term with an intrauterine death. She had attended the previous day with reduced fetal movements and had a CTG performed. This was interpreted as being normal despite absence of accelerations in the fetal heart rate, and the woman was discharged from hospital. She re-attended a few hours later still concerned about the lack of fetal movements, and was kept waiting for two hours before being seen, following which the baby was found to have died. ‘Example from MBRRACE report, November 2015