Quality standard

Quality statement 4: Stopping cardiotocography

Quality statement

Women at low risk of complications who have cardiotocography because of concern arising from intermittent auscultation have the cardiotocograph removed if the trace is normal for 20 minutes.

Rationale

Cardiotocography is offered to women if intermittent auscultation indicates possible fetal heart rate abnormalities. However, cardiotocography that is started for this reason should be stopped if the trace is normal for 20 minutes, because it restricts the woman's movement and can cause labour to slow down. This can lead to a cascade of interventions that may result in adverse birth outcomes.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that women at low risk of complications having cardiotocography because of concern arising from intermittent auscultation have the cardiotocograph removed if the trace is normal for 20 minutes.

Data source: Local data collection.

Process

Proportion of women at low risk of complications who have cardiotocography because of concern arising from intermittent auscultation have the cardiotocograph removed if the trace is normal for 20 minutes.

Numerator – The number in the denominator who have the cardiotocograph removed.

Denominator – The number of women in labour at low risk of complications who have cardiotocography because of concern arising from intermittent auscultation and who have a normal trace for 20 minutes.

Data source: Local data collection.

Outcome

Maternal satisfaction and experience of care.

Data source: National data is collected as part of the Care Quality Commission's Maternity Survey: section C ('Your labour and the birth of your baby').

What the quality statement means for different audiences

Service providers (for freestanding midwifery units, alongside midwifery units and obstetric units) have evidence of local arrangements to ensure that protocols are in place so that women in labour at low risk of complications who have cardiotocography because of concern arising from intermittent auscultation have the cardiotocograph removed if the trace is normal for 20 minutes.

Healthcare professionals (midwives and obstetricians) remove the cardiotocograph if the trace is normal for 20 minutes for women at low risk of complications who have cardiotocography because of concern arising from intermittent auscultation.

Commissioners (clinical commissioning groups or integrated care systems) specify and check that service providers have protocols in place to ensure that women in labour at low risk of complications who have cardiotocography because of concern arising from intermittent auscultation have the cardiotocograph removed if the trace is normal for 20 minutes.

Women who are at low risk of problems during labour, but who have electronic monitoring because of possible concerns about the baby's heartbeat, are taken off the monitor if the baby's heartbeat is normal for 20 minutes.

Source guidance

Intrapartum care for healthy women and babies. NICE guideline CG190 (2014, updated 2017), recommendations 1.4.12 and 1.10.8

Definitions of terms used in this quality statement

Normal cardiotocograph trace

A normal trace has the following normal/reassuring features:

  • baseline fetal rate of 100 to 160 beats per minute and

  • baseline variability of 5 to 25 beats per minute and

  • no or early decelerations and

  • variable decelerations with no concerning characteristics for less than 90 minutes.

It should be noted that while variable decelerations of less than 90 minutes is a reassuring feature, the trace should not be removed at 20 minutes if these are present without further assessment. [NICE's guideline on intrapartum care for healthy women and babies, table 10, and expert opinion]