Book Review
The CTG in practice
Balen A. K, Smith J. H.
ISBN: 0 443 046751; 1992; 203 pages; Churchill Livingstone Edinburgh;
Jane Stevenson
Flinders Medical Centre
The authors of this book set out to develop a learning tool to aid midwives and medical officers in the interpretation of CTG's (cardiotocographs) both antenatally and throughout labour. They attempted to demonstrate, using a wide range of case studies, how technology can be an adjunct (or a hindrance in certain circumstances) when utilized in the care of pregnant women. The writers have included a large variety of CTG tracings, with accompanying comprehensive histories in most cases. These encompass many scenarios which the practicing labour ward midwife or doctor may encounter on a daily basis.
Each case has details of the antenatal history and the progress of labour (including a partogram where available) with excellent documentation of the outcome so the reader may develop an understanding of the events influencing each pregnancy and labour. Following many of the cases the authors have included a 'clinical points' section where an aspect of management of an emergency procedure is discussed in detail, for example cord prolapse (p 114).
This is an excellent method of reinforcing specific management pathways for particular scenarios and will allow readers to broaden their knowledge base and analyse whether they would apply the recommended form of management in similar clinical situations if confronted with the problem under discussion. The authors have employed good cross referencing under the 'clinical points' section when included. Unfortunately there are many statements made throughout this book that are not supported by references, such as 'variability is greater at night and lowest between 0600 and 1200' (p 3). A statement such as this needs to be validated by reliable evidence. In fact there is no referencing at all throughout the book, which may influence some readers to question the value of it as a reliable information source and reference text. Midwives and doctors of varying experience would find this book of value as a reference to use for interpretation of CTGs in labour.
However the novice reader may find some of the terminology used a little overwhelming as detailed explanations of some clinical points and conditions are not always included. The authors appear to assume knowledge that not all readers may possess. For example on page 5, a CTG demonstrating rest/activity cycling in labour is shown but there is no indication as to which area of the tracing is a rest cycle and which is an activity cycle. To aid the uninitiated reader these areas could have been highlighted therefore enabling easier comprehension. The index appears to be comprehensive and highlights pages on which clinical points are discussed which would enable the reader to easily access particular areas where more information and knowledge is needed.
The authors also include a valuable list of abbreviations at the beginning of the book. This book is a valuable reference tool and will be useful as a method of initiating lively discussion amongst professionals for alternate pathways of management for specific problems encountered within the labour ward environment. As mentioned by the authors, the inclusion of fetal scalp blood sampling as an adjunct in supporting management would have been a useful inclusion. The book does encompass varied aspects of labour ward care and does give advice '...not always to be found in conventional text books' (p V). This book is recommended as a valuable asset to a reference library especially within the labour ward situation. Midwifery and medical students as well as trained professionals would find it a valuable learning tool.
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