The use of foetal electrocardiogram was introduced by St. George to address CTG abnormalities

Obstetrics and Gynaecology

Winner: St George’s University Hospitals Foundation Trust

Cardiotocography (CTG) is an important means of recording a baby’s heartbeat and the contractions of the womb. If it indicates abnormalities in the baby’s heart rate, the decision may be taken to perform an emergency caesarean section or an assisted delivery.

However, research has shown significant variation in how individual practitioners interpret a cardiotocograph. This can lead to unnecessary interventions, which are associated with a higher risk of maternal and perinatal morbidity and mortality.

An Intrapartum Foetal Monitoring Strategy was developed at St George’s to address the issue. Intensive training on physiology-based CTG interpretation and the use of foetal electrocardiogram was introduced, along with mandatory competency testing for all midwives and obstetricians.

If CTG indicates abnormalities in the baby’s heart rate, the decision may be taken to perform an emergency caesarean section or an assisted delivery.

The result is the lowest reported emergency caesarian rate in London – 7.8 per cent, less than half the rate reported by any other London teaching hospital with a similar number of complexity of births.

This not only reduces health risk to mothers and babies, but results in significant financial savings due to reduced inpatient stay and reduction in theatre costs.

Judges’ comment: Good outcomes – demonstrated value and impact.

Highly commended: Wrightington, Wigan and Leigh Foundation Trust.