A survey of regional guidelines for intrapartum electronic fetal monitoring in women at low obstetric risk

Aim: to determine whether intrapartum fetal monitoring guidelines used by midwives in one region of England for women at low risk of obstetric complications were evidence-based. Objective: to assess the quality of such guidelines using an appraisal tool. Design and setting: an appraisal of guidelines gained via a postal survey of all National Health Service Trusts supplying maternity services in one region in the north of England, conducted over a six-week period (June-July 2001). Participants: 28 Trusts were eligible to participate; 32 guidelines were returned from 24 Trusts. Data analysis: two reviewers from a multi-disciplinary panel appraised each guideline, producing two sets of data that were analysed independently of each other. Each was treated as a separate case (n = 64 cases). Inter-reviewer agreement was summarised using descriptive categories. Findings: the highest possible overall quality score was 54, and the lowest 18. Whilst no guideline scored 54, five of the 64 cases scored 18. The mean overall quality score was 26.8. In 36 of the 64 cases, both reviewers rated guidelines as 'definitely not' recommended for practice. Guidelines were scored against specific aspects of evidence-based practice. Forty-one of the 64 cases received the lowest possible quality score (= '1') for use of systematic reviews of the literature on electronic fetal monitoring. In 47 cases, guidelines were scored '1' for the quality of evidence-based clinical recommendations. The quality of information on client monitoring preferences was considered low in over half the 64 cases (n = 35). There were no instances where the number of cases receiving 'highest possible quality' scores was greater than those receiving 'lowest possible quality' ratings. Conclusions and implications for practice: a small number of guidelines were assessed as high quality, but the majority were poorly appraised by the reviewer group in most areas. This has implications for the delivery of evidence-based midwifery care since those midwives practising according to the guidelines surveyed would not have been supported in implementing research into practice. (C) 2004 Elsevier Ltd. All rights reserved.