Monitoring in pregnancy – why is it important?

In cases involving baby loss or birth injuries, whether monitoring was done properly or interpreted accurately is a key factor to investigate.

One of the most important tools used during pregnancy to monitor the health of the baby is called the cardiotocograph (CTG).

CTG is a non-invasive test that is used to monitor the baby’s heartbeat and the mother’s contractions. It is typically done in the third trimester of pregnancy, but it can also be done earlier if there are concerns about the baby’s health. During the test, two sensors are placed on the mother’s belly, one to monitor the baby’s heartbeat and the other to measure the contractions of the uterus.

The test is important because it can give doctors key information about the baby’s health. For example, if the baby’s heart rate is too high or too low, it could be a sign that the baby is not getting enough oxygen or that there is a problem with the placenta. If in labour and the contractions are too frequent or too strong, it could also be a sign of a problem.

The Dawes-Redman criteria

The Dawes-Redman criteria, also known as the Dawes-Redman CTG, is a test used during pregnancy to monitor the baby’s heartbeat and the mother’s contractions. It is typically used in cases where there are concerns about the baby’s health or in high-risk pregnancies.

The Dawes-Redman CTG, is a computerised interpretation of the results of the CTG. The criteria look at several factors, including the baseline fetal heart rate, the variability of the fetal heart rate, the presence or absence of accelerations, and the presence or absence of decelerations. The criteria also include short-term variation (STV) – how the baby’s heartbeat varies from beat to beat. It can’t be seen by eye and can only be looked at with computerised CTG because it measures in milliseconds.

Considering all these factors and whether the criteria are met or not, can help doctors determine if the baby is healthy or if there are concerns about the baby’s health.

If the Dawes-Redman criteria are not met within 60 minutes following the start of the CTG, it means that there is not enough evidence to show everything is ok and it should be continued.

Recent Study

A recent study in the British Journal of Obstetrics and Gynaecology (BJOC)[1], published in April 2023, looked back at over 21,000 records where antenatal monitoring had taken place between 2000 and 2020 to see if stillbirths occurred more frequently when the Dawes Redman criteria had not been met.  It found that around 1 in 16 pregnancies did not meet the criteria (more often in lower gestation pregnancies than in full term pregnancies) and there was a higher risk of stillbirth in this group. 

The authors conclude that if the Dawes-Redman criteria are not met and the STV is below 8 milliseconds, pregnancies should be followed up more closely.  It is helpful in identifying pregnancies that require follow up and review, which could avoid possible stillbirths.

Our team understands the importance of CTG monitoring in pregnancy. This expert knowledge ensures we can evaluate whether standards were met in a particular case and can highlight whether errors occurred as a result of negligence.

This understanding enables us to engage effectively with experts and investigate a case thoroughly, testing the evidence and evaluating the strength of a case and ultimately obtain answers and justice for our clients.

[1] The significance of meeting Dawes–Redman criteria in computerised antenatal fetal heart rate assessment – Bhide – BJOG: An International Journal of Obstetrics & Gynaecology – Wiley Online Library

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