Problems with CTG
1. Expectation of benefit of CTGs doesnt match the evidence
2. We treat CTG monitoring as innocuous. Its not
3. It relies on the fetal parameter of heart rate ONLY to assess wellbeing....variability, accels/decels are back to that single fetal parameter. https://twitter.com/DrBrendanMcD/status/1273549640139509765

3. Midwives and obstetricians will often disagree on interpretation of same trace
4. Individual midwives and obstetricians will disagree with themselves when looking at same trace at different times
5. A baseline CTG is not a good indicator that a fetus has not been compromised

6. Belief by some that 'if we don't do it then we are exposed legally'....why do we apply this mantra to CTGs and a few other things in maternity care but it's ok to use evidence for or against other interventions and practice accordingly?

7. Rarely are women informed of the evidence of the benefits (yes) and harms (yes) associated with CTG yet we inform women about the much smaller risks of less harm associated with other interventions e.g., risk of post dural puncture headache after an epidural...that's not right

8. Most of the evidence on association of features of CTG (some of which is not great) with clinical outcomes is derived from term infants and yet CTGs are done on pre-term infants frequently in some centres without criteria for how to interpret the tracing (whats 'normal')

9. The impact of CTGs on caesarean section is virtually identical across risks we assign to women....no good evidence of benefit for higher risk groups and evidence of higher CS etc .....this is at odds to recommendations from most professional bodies on use of CTG.

10. Much of above has been known for decades