The Role of Cardiotocography in Preventing Birth Injuries

In terms of birth injuries, medical errors involving fetal heart rate monitoring are among the more common.  Fetal heart rate monitoring, also called cardiotocography (CTG), is important in preventing birth injuries like infant brain damage and injuries to the mother.  In September 2017, NHS Resolution released information suggesting that a large number of cerebral palsy cases may be the result of cardiotocography errors.

Let’s take a closer look at what research shows, and why every expectant parent should be familiar with cardiotocography.  To learn more about birth injuries and improper fetal heart rate monitoring, contact Birth Injury Guide.

What is Cardiotocography?

Cardiotocography is the technical term for monitoring fetal heart rate and uterine contractions during labor.  Broken down, “cardiograph” relates to evaluation of the heart rate, and “tocograph” relates to the recording of uterine contractions.  The purpose of cardiotocography is to monitor fetal wellbeing and alert healthcare providers if the fetus becomes distressed.  If the fetus becomes distressed, healthcare providers must take action to investigate the situation, determine problems, and if necessary, initiate an emergency Cesarean section (c-section).

The information gathered in cardiotocography is relayed to doctors and midwives in real time, and can be valuable in determining the health of the infant, and the status of labor.  Fetal heart rate monitoring can be achieved in two different ways – external or internal – which include the following:

  • External: External cardiotocography may include ultrasound through the abdominal wall, or placement of a tocodynamometer at the fundus of the mother’s uterus.
  • Internal: Internal cardiotocography may include placement of an electrode on the scalp of the fetus while still in the womb. Internal monitoring is more accurate because maternal and fetal movements do not interfere with the monitoring.

Based on the information provided through monitoring, healthcare providers must make choices in the best interests of the mother and child.  Interpretation of monitoring reports include assessment of:

  • Baseline fetal heart rate: The average heart rate over a period of time, generally 10 minutes. A “normal” fetal heart rate is 110-150 beats per minute (BPM).
  • Baseline variability: If the variability of the fetal heart rate is 5 BPM or less, then it is considered abnormal. A normal variability is 5 BPM or greater.
  • Fetal heart rate acceleration: An “appropriate response” to a uterine contraction is an acceleration of the fetal heart rate.
  • Fetal heart rate deceleration: Any abrupt deceleration in the fetal heart rate may be a sign of distress. A deceleration of 15 BPM for a period of 15 seconds or longer is considered abnormal.

It is important for expectant parents to know that fetal heart rate may be impacted by a variety of factors, including fetal and maternal health.  Some of the maternal health conditions that may influence fetal heart rate include:

  • Maternal fever
  • Placental abruption
  • Uterine rupture
  • Preeclampsia
  • Gestational diabetes

Any of these conditions can impact fetal heart rate and the amount of oxygen transported to the baby.  Signs or symptoms of any of these conditions should be taken seriously, and healthcare providers should act quickly.

Cardiotocography and Birth Injuries

In any sort of diagnostics or monitoring, there is a certain level of uncertainty in interpretation.  That is why it is so important that healthcare providers understand systems like cardiotocography and how to properly interpret results and take action.  Currently, cardiotocography is the most effective way of monitoring fetal heart rate and uterine contractions.  Unfortunately, it continues to be one of the most common factors in birth injuries.

In September 2017, NHS Resolution reviewed 50 cerebral palsy cases and found that 32 of them involved errors in interpretation of cardiotocography reports.  These injuries may have been the result of improper interpretation, delays in responding to distress, improper monitor placement, or failure to order a c-section in a timely manner.  These are just a few of the ways that interpretation could result in birth injuries.

As noted, one of the most common birth injuries resulting from cardiotocography errors is cerebral palsy.  In addition, other birth injuries may include:

This list is not exhaustive.  To find out more about possible injuries caused by cardiotocography errors, contact your healthcare provider.

Protecting Your Health and Legal Rights

As a patient, you have certain expectations when you seek medical attention.  You expect your healthcare providers to provide safe, quality care that is in your best interests.  Unfortunately, that does not always happen.  As humans, we are all prone to mistakes, and sometimes birth injuries are the result of a true mistake.

In many other cases, however, birth injuries are caused by negligence – be it improperly monitoring fetal or maternal health, failure to address red flags or failure to take action in a timely manner.  In any case, not only have your expectations been shattered, but your legal rights may have been as well.

If you or your child have been injured due to any of the factors discussed in this article, contact Birth Injury Guide for a free case review with one of our birth injury attorneys.  Our staff and team of attorneys have knowledge and experience you can count on to understand your situation and take action.  To get started, fill out our online form, or call our office at 1-877-415-6603.

Meagan Cline

Written By Meagan Cline

Meagan Cline is a professional legal researcher and writer. She lends her expertise to the team at Birth Injury Guide to provide up-to-date and relevant content that clients can count on.