Training in the use of intrapartum electronic fetal monitoring with cardiotocography: systematic review and meta-analysis

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jats:secjats:titleBackground</jats:title>jats:pSub‐optimal classification, interpretation and response to intrapartum electronic fetal monitoring using cardiotocography are known problems. Training is often recommended as a solution, but there is lack of clarity about the effects of training and which type of training works best.</jats:p></jats:sec>jats:secjats:titleObjectives</jats:title>jats:pSystematic review of the effects of training healthcare professionals in intrapartum cardiotocography (PROSPERO protocol: CRD42017064525).</jats:p></jats:sec>jats:secjats:titleSearch strategy</jats:title>jats:pCENTRAL, Cochrane Library, MEDLINE, EMBASE, PsycINFO, British Nursing Database, CINAHL, ERIC, Scopus, Web of Science, ProQuest, grey literature and ongoing clinical trials were searched.</jats:p></jats:sec>jats:secjats:titleSelection criteria</jats:title>jats:pPrimary studies that reported impact of training healthcare professionals in intrapartum cardiotocography. Title/abstract, full‐text screening and quality assessment were conducted in duplicate.</jats:p></jats:sec>jats:secjats:titleData collection and analysis</jats:title>jats:pData were synthesised both narratively and using meta‐analysis. Risk of bias and overall quality were assessed with the Mixed Methods Appraisal Tool and GRADE.</jats:p></jats:sec>jats:secjats:titleMain results</jats:title>jats:pSixty‐four studies were included. Overall, training and reporting were heterogeneous, the outcomes evaluated varied widely and study quality was low. Five randomised controlled trials reported that training improved knowledge of maternity professionals compared with no training, but evidence was of low quality. Evidence for the impact of cardiotocography training on neonatal and maternal outcomes was limited, showed inconsistent effects, and was of low overall quality. Evidence for the optimal content and method of delivery of training was very limited.</jats:p></jats:sec>jats:secjats:titleConclusions</jats:title>jats:pGiven the scale of harm and litigation claims associated with electronic fetal monitoring, the evidence‐base for training requires improvement. It should address intervention design, evaluation of clinical outcomes and system‐wide contexts of sub‐optimal practice.</jats:p></jats:sec>jats:secjats:titleTweetable abstract</jats:title>jats:pTraining in fetal monitoring: systematic review finds little evidence of impact on neonatal outcomes.</jats:p></jats:sec>

Caesarean, clinical outcome, fetal heartbeat monitoring, fetal heartrate monitoring, health personnel, intervention, intrapartum, Kirkpatrick model, mixed methods, neonatal, observational study, pregnancy
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BJOG: An International Journal of Obstetrics and Gynaecology
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This work was funded by the Health Foundation’s grant to the University of Cambridge for The Healthcare Improvement Studies (THIS) Institute (RG88620). PR is funded by the National Institute for Health Research (NIHR) as an academic clinical lecturer. Mary Dixon-Woods holds an NIHR Senior Investigator award.