Use of Continuous Electronic Fetal Monitoring in a Preterm Fetus: Clinical Dilemmas and Recommendations for Practice

Table 3

Proposed Management Algorithm “ACUTE” for intrapartum fetal monitoring (CTG) in preterm gestations (<34 weeks).

A	Assess survival and long-term outcome at the given gestational age.
C	Consider the wider clinical picture:presence of co-existing infection, maternal age, condition of the fetus (severe growth restriction, congenital malformations), wishes of the woman (e.g., request to “do everything possible” in view of IVF conception, previous preterm losses) in formulating management plan.
U	Understand normal fetal cardiovascular and nervous system physiology at the given gestation in interpreting the CTG.
T	Treatment of underlying predisposing factors of uterine irritability (infection, antepartum haemorrhage) and treatment of preterm labour (tocolytics and steroids, if appropriate) to optimise maternal and fetal outcome.
E	Evaluate maternal risks of operative interventions (classical C. section, haemorrhage, infections, increased risk of uterine rupture in future pregnancies) and potential fetal benefits (survival and long-term morbidity) due to commencing continuous electronic fetal monitoring at the given gestation and counsel appropriately.