Preterm labour and birth

Preterm labour and birth

NICE guideline [NG25] Published date: November 2015

1.11 Fetal monitoring

Monitoring options: cardiotocography and intermittent auscultation

1.11.1 Discuss with women in suspected, diagnosed or established preterm labour (and their family members or carers as appropriate):

• the purpose of fetal monitoring and what it involves
• the clinical decisions it informs at different gestational ages
• if appropriate, the option not to monitor the fetal heart rate (for example, at the threshold of viability).

1.11.2 Involve a senior obstetrician in discussions about whether and how to monitor the fetal heart rate for women who are between 23⁺⁰ and 25⁺⁶ weeks pregnant.

1.11.3 Explain the different fetal monitoring options to the woman (and her family members or carers as appropriate), being aware that:

• there is limited evidence about the usefulness of specific features to suggest hypoxia or acidosis in preterm babies
• the available evidence is broadly consistent with that for babies born at term (see monitoring during labour in the NICE guideline on intrapartum care)
• a normal cardiotocography trace is reassuring and indicates that the baby is coping well with labour, but an abnormal trace does not necessarily indicate that fetal hypoxia or acidosis is present.

1.11.4 Explain to the woman (and her family members or carers as appropriate) that there is an absence of evidence that using cardiotocography improves the outcomes of preterm labour for the woman or the baby compared with intermittent auscultation.

1.11.5 Offer women in established preterm labour but with no other risk factors (see monitoring during labour in the NICE guideline on intrapartum care) a choice of fetal heart rate monitoring using either:

• cardiotocography using external ultrasound or
• intermittent auscultation.

1.11.6 For guidance on using intermittent auscultation for fetal heart rate monitoring, see monitoring during labour in the NICE guideline on intrapartum care.

Fetal scalp electrode

1.11.7 Do not use a fetal scalp electrode for fetal heart rate monitoring if the woman is less than 34⁺⁰ weeks pregnant unless all of the following apply:

• it is not possible to monitor the fetal heart rate using either external cardiotocography or intermittent auscultation
• it has been discussed with a senior obstetrician
• the benefits are likely to outweigh the potential risks
• the alternatives (immediate birth, intermittent ultrasound and no monitoring) have been discussed with the woman and are unacceptable to her.

1.11.8 Discuss with the woman (and her family members or carers as appropriate) the possible use of a fetal scalp electrode between 34⁺⁰ and 36⁺⁶ weeks of pregnancy if it is not possible to monitor the fetal heart rate using either external cardiotocography or intermittent auscultation.

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