28 yrs old para 1, delivered previously vaginally, healthy baby. In the current pregnancy admitted with diarrhea, ctg pattern showed double baseline at 140's and 100bpm. Kindly outline the significance of such a ctg trace.
This clinical query answer was produced by RCOG Library staff following the clinical query protocol as described here .
Answer: The Medicines and Healthcare products Regulatory Agency (MHRA) issued a Medical Device Alert in 2010 which highlights incidents where the CTG trace showed the FHR was around 160 bpm. It was later suspected that in both cases the trace was showing double maternal rate and was falsely reassuring. The alert outlines the following action:
"Local procedures for maintaining expertise should ensure that relevant clinical staff:
An appendix reproduces the relevant section from the NICE guideline.
(Evidence level IV)
Medicines and Healthcare products Regulatory Agency. Fetal monitor/cardiotocograph (CTG) . MDA/2010/054. London: MHRA, 2010.
Search date: April 2013
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
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