Admission CTG's

In my trust there are quite clear guidelines on ctg... Admission traces are only done on women with risk factors such as reduced fetal movements, oligohydramnios, twins, known meconium liquor etc and to be honest they tend to stay on them continuosly throughout labour.

If women are querying pre-labour SROM, they will have an admission ctg prior to speculum examination and if the trace is reassuring it will be discontinued after 20mins. If women are coming in for IOL with prostin they will have an admission CTG that must be reassuring for 20mins prior to administration and then they will stay on the CTG for 2 hours after administration, if at that point the trace is still good it will be discontinued to enable mobilisation.

Intermittent auscultation with pinnard on admission (within 20 mins) is in the guidelines for low risk women followed by I.intermittent auscultation with sonicaid or pinnard (midwife personal preference). This will continue 1/2 hourly to 1 hrly if not in established labour depending on why the woman is being monitored and change to 1/4 hourly when labour is established. Obviously if any risk factors develop then continuous monitoring with CTG will commence.

Women who request an epidural will have a CTG for 20 mins prior to administration providing it is reassuring, if it isn't they will be reviewed by the doctor who will advise whether to go ahead or not with the epidural. Once the epidural is in place the monitoring tends to be continuous, although I queried this as in the guidelines it says it can be intermittent if reassuring after 30 mins and would only need to be started again if blouses were administered. The response was that we'd be taking them off and putting them back in all day if we were to do that... Which I kind of understood!

No admission ctgs unless they've come in with a risk factor like pv bleed, reduced movements etc. or if high risk labourer (eg diabetes etc). SROMs just get intermittent monitoring unless other complication.

If not in established labour then we'll auscultate only at the point of care- so maybe hourly or even longer if care is not required! If induction lady begins contracting regularly while on the ward we'll do a CTG and VE. reassess after 4 hrs if still not in labour. Will always auscultate if anything changes eg bleeding srom obviously.

At the hospital I trained we did a CTG for everyone when they came in. This in itself isn't such a problem, as once you do vital signs, have a chat and write a few notes the 20 minutes for admission CTG is up. However, it did tend to lead to a lot more intervention - if anything occured during that 20 minutes it was then difficult to justify taking the CTG off hoping my new job won't have these guidelines.

Same as Potbella......although there is still some outdated practice amongst some mw's who insist on an admission CTG to assess 'fetal wellbeing'!! despite the fact that there is no evidence to support this.....some of my fellow students have had real problems with this, and walking that fine line between what we know is evidence based, how we bring that up with the mw we're working with, and working with that mw all day who has to sign off our essential skills - it can be tricky!

My trust are sooo CTG happy!:ban:
Every antenatal admission is put straight on the CTG.... why?!? As Muffinbuns said, it just seems to lead to increased intervention as any slight deviation from 'normal' on the trace is reviewed and either ends up with the woman strapped to the machine for the next hour and a half, 2 hours to get a more 'reassuring' trace or it starts a cascade of completely unnecessary intervention. As a first year, I feel like I don't know enough about CTG protocol and indications to argue my point but it's like the midwives have become institutionalised to use routine CTG in an attempt at defensive practice.

I'm not a midwife or student yet but when I was in labour I was on arrival given a ctg which showed that my lo had dips in her heart rate, this led to me being confined to bed and monitored for the next 4 hours and although at one point the dips ceased, they started back up again but worsened and resulted in an emergency c-sec. For a while after her birth I was thankful that they had 'caught it early' ensuring her safe arrival, but recently I can't help but wonder if I had not been monitored so closely and was allowed freedom to move during my labour, would the result have been the same!? She had been playing with the cord which is why the dips occurred but it does make me question, if I had been able to change my position and had a more active labour, would my baby have also reacted in the same way!? I think some hospitals are too scared of the consequences and end up being over cautious which results in an increase of intervention.