Challenges and practical steps to optimizing the utilization of electronic fetal monitoring in low and medium income countries: The UBTH experience

Electronic fetal monitoring with special emphasis on cardiotocography (CTG) has become indispensable in the management of pregnancy and labor, especially in the high-risk parturient. While this is an essential part of the practice in high-income countries, many low- and medium-income countries (LMICs) lack the facilities and skill to deploy the technology in their centers. The reasons for this stem from various issues including lack of knowledge on the significance of the tool, lack of training in the acquisition and interpretation of the trace, inordinate fear of the presumed increase in Caesarean section rate, equipment cost and maintenance, among others. In this commentary, the lessons learnt from the 10-year experience of the implementation of CTG monitoring at the Maternal and Fetal Unit of the Department of Obstetrics and Gynecology of the University of Benin Teaching Hospital, Benin City are shared. The basic steps necessary to commence the service are proposed. The issue of training and retraining is emphasized while also highlighting the necessity of preventive maintenance of the equipment. The challenges of the program and limitations of the report are also brought to the fore. Despite these drawbacks, in the spirit of the peer review system for the introduction and sustenance of contemporary medical technology in LMICs, it is believed that sharing these experiences will help build an enduring system capable of improving service delivery and practice in these regions.