S1-Guideline on the Use of CTG During Pregnancy and Labor

1 Purpose

1.1 Aim, target audience and method

The aim of this consensus paper is to standardize the use of cardiotocograms (CTG) in fetal monitoring using an evidence-based approach. Recommended standards take the impact of disturbances and other influencing variables on the CTG into account, use standard definitions and objective assessment methods, and look at upstream diagnostic procedures and adjunct monitoring methods.

The target audience for this consensus paper are all professionals who use CTG readings to monitor pregnancies and childbirth, most notably gynecologists and midwives.

Method: This guideline was compiled with particular reference to and in consideration of previous recommendations [85], the FIGO guidelines [59], [82], and the guidelines of the Royal College of Obstetricians and Gynaecologists [84], the NICHD [72], the Society of Obstetrics and Gynecologists Canada [110] and the American College of Obstetricians and Gynecologists [4], [5] as well as evidence-based data, where available.

The basis for this guideline is the best available “evidence” which was carefully collected and classified by the members of the consensus group.

It was not possible in every case to compile recommendations directly from the evidence level provided in the available literature. The recommendations show what is generally considered good clinical practice, so far as this was not queried by the persons involved in the consensus process. With regard to the requirements specified by the AWMF for the compilation of guidelines in terms of a uniform structure for different guideline types (S1, S2e, S2k, S3), the levels of recommendation in this S1 guideline on recommended actions are not stated explicitly but are indicated using the terms “shall”, “should” and “can”. Transparency is given in the background text, which lists the level of evidence of cited studies.

The level of evidence is as follows ([Table 1]):

Table 1 Evidence level (EL) (from [84]).*

Level	Evidence
* The first version of this guideline was compiled in 2003 and published in 2004, in other words, prior to the development of the DELBI and AWMF criteria for defining the level of evidence. The level of evidence was determined in analogy to the evaluation of guidelines issued by foreign professional associations (s. above) and this form of assessment was retained in the revised version of the guidelines.
I a	Systematic review with meta-analysis of randomized controlled studies
I b	At least one randomized controlled trial
II a	At least one well-designed controlled study without randomization
II b	At least one other type of well-designed quasi-experimental study
III	Well-designed non-experimental descriptive study, e.g. comparative, correlation and case studies
IV	Expert committee reports or opinions and/or clinical experiences of respected authorities

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