Objectives: To assess if introduction of digital CTG pop-up box with the guidance for CTG interpretation improves the rate of compliancy review, accuracy of interpretation, prompt action taken on pathological CTG and the rate of adverse perinatal outcome. The digital guidance for CTG interpretation aim to supports decision making during labour and improve the quality of intrapartum fetal monitoring and its management in maternity services

Methods: Intrapartum data and CTG were collected on labouring women at UMMC from December 2015 to the end of June 2016.  We introduced a digital system to aid interpretation of CTG in March 2016. Our study period was three months before and three months after this date.  Comparisons were made between conventional CTG paper tracings with digital CTG, specifically in cases diagnosed as ‘fetal distress’. Two reviewers agreed on accuracy of CTG interpretation. Data were also collected on adverse neonatal outcomes during this study period. These are term newborns admitted to Neonatal Unit, Low Apgar score (less than 7 at 5 minutes of life), and cord pH less than 7.1. In these newborns, we assessed the documented rate of CTG reviews, the accuracy of CTG interpretation and whether appropriate action was taken when CTG was interpreted as ‘pathological’. Comparison on the compliancy of CTG reviews, accuracy of CTG interpretation, the rate of documented prompt action taken on pathological CTG and the rate of adverse perinatal outcome is compared.

Results: Documentation on the compliance of CTG review every 30 minutes were statistically significantly different between the two periods 14.7%, (95% CI 9.3-20.2) vs 46.4%, (95% CI 38.5-54.3). Accurate CTG interpretation as per NICE Guideline was found in 42.9%, (95% CI 35.3-50.5) prior to implementation of digital CTG and shows improvement 56.8%, (95% CI 49.0-64.7), although it is not statistically significant. Prompt action taken for pathological CTG shows statistically significant difference between both group 33.4% (95% CI 27.1-41.7) vs 58.8% (95%CI 49.0-64.7). The adverse perinatal outcome improved although it is not statistically significant 27 % (95% CI 20.2-33.8) in conventional CTG vs 17% (95% CI 11.1-23.0) in digital CTG, most likely due to the small sample size.

Conclusion: This study has shown that the introduction of digital CTG pop up box to guide CTG interpretation have significantly improved the compliancy of CTG review, and the rate of prompt action taken on pathological CTG.