Letters

Cardiotocography v Doppler auscultation

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7335.482 (Published 23 February 2002) Cite this as: BMJ 2002;324:482

Guidelines highlight gaps in research evidence

  1. Jane Thomas, director,
  2. Shantini Paranjothy, clinical research fellow,
  3. Tony Kelly, clinical research fellow,
  4. Josephine Kavanagh, research fellow
  1. Royal College of Obstetricians and Gynaecologists, Clinical Effectiveness Support Unit, London NW1 4RG
  2. Royal Cornwall Hospital (Treliske), Truro TR1 3LJ
  3. UK Cochrane Centre, Oxford OX2 7LG
  4. Department of Obstetrics and Gynaecology, The Queen Mother's Hospital, Glasgow G3 8SH
  5. Diana, Princess of Wales Hospital, Grimsby DN33 2BA
  6. Royal United Hospital, Bath BA1 3NG
  7. Ninewells Hospital and Medical School, Dundee DD1 9SY

    EDITOR—The clinical effectiveness support unit of the Royal College of Obstetricians and Gynaecologists has recently developed the guideline of the National Institute for Clinical Excellence (NICE) on the use of electronic fetal monitoring.1 One of the potential benefits of guidelines is to highlight gaps in research evidence. As part of the guideline development process we conducted a survey of maternity units in England and Wales to evaluate the current use of electronic fetal monitoring in intrapartum care.2

    The guideline recommends that in women who are healthy and have an uncomplicated pregnancy, intermittent auscultation is a suitable method of monitoring during labour. This recommendation was based on the evidence from nine randomised controlled trials that have enrolled 18 000 and are included in three systematic reviews.1 This conclusion was reached because screening with continuous electronic fetal monitoring should not be conducted in the absence of evidence of benefit. This recommendation will perhaps have a minimal impact in practice as the survey found that only 2.5% of units report using continuous electronic fetal monitoring for all women in labour.

    Most maternity units (79%), however, reported using admission cardiotocography in the initial assessment of women who are healthy and have had an otherwise uncomplicated pregnancy. When evaluating the research that exists to support the use of admission tests in populations at low risk we were surprised to find only a single cohort study that addressed this issue; this cohort study included only 1041 women and related admission tests to fetal distress.3 The trial by Mires et al is the first published randomised controlled trial to address this clinically important question. The study is also nearly four times the sample size of previous studies. As such it would have been important to publish this trial irrespective of whether the results …

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