Structured CTG Training Boosts Fetal Monitoring Skills of Nurses and Midwives

A structured training program in cardiotocography substantially improved both the hands-on performance and the fetal heart rate interpretation skills of maternity nurses and midwives, according to a quasi-experimental controlled study conducted at Al Thaghr General Hospital in Jeddah, Saudi Arabia. The findings, published in BMC Nursing, showed that the gains were still clearly measurable three months after the training ended, although they had slipped slightly from their peak immediately after the course. Cardiotocography, or CTG, is widely used for intrapartum fetal monitoring, but the quality of monitoring depends in part on clinicians' procedural performance and their interpretation of fetal heart rate traces.

The researchers set out to evaluate changes in these two measured competencies associated with a structured, competency-based training program among frontline maternity staff. The study included 64 maternity nurses and midwives, split into an intervention group of 32 and a control group of 32. Because the trial was non-randomized, participants were allocated using a pre-specified procedure based on duty rosters and clinical work schedules rather than by chance.

The intervention consisted of three standardized sessions, each lasting 45 to 60 minutes, delivered within a three-week window. Assessment relied on two instruments: a 22-item CTG Performance Observational Checklist scored from 0 to 22, and an 11-item FHR Trace Interpretation Assessment scored from 0 to 11. Evaluations took place at three points—baseline, immediately after training, and at a three-month follow-up.

Importantly, the outcome assessors were independent of those delivering the training and were blinded to which group each participant belonged to, reducing the risk of biased scoring. The results were striking. Practical performance scores in the intervention group rose from a mean of 10.81 ± 2.16 at baseline to 18.31 ± 1.64 immediately after training, settling at 17.62 ± 1.70 at three months.

The control group barely moved over the same period, with means of 10.88 ± 2.11, 11.16 ± 2.20, and 10.97 ± 2.29 at the three time points. The statistical test for the interaction between group and time yielded F(2,124) = 712.17 with p less than .001 and a partial eta-squared of 0.920, indicating that an exceptionally large share of the variance in scores was explained by the combination of group membership and time. Interpretation of fetal heart rate traces followed a parallel trajectory.

The group-by-time interaction was again significant, F(2,124) = 287.80, p less than .001, with a partial eta-squared of 0.823. One nuance stands out in the data: both outcomes in the trained group declined modestly between the immediate post-test and the three-month follow-up. Even so, Bonferroni-adjusted pairwise comparisons confirmed that the three-month scores remained significantly above baseline, with adjusted p values below .001.

All 64 participants completed all three assessments, so the results are not complicated by dropout. The authors are careful to temper the enthusiasm. The study's limitations include the non-randomized allocation, a single-center convenience sample, repeated use of the same assessment forms, and the absence of any maternal or neonatal outcome measures.

Because participants were assigned by work schedule rather than randomization, unmeasured differences between the groups could have influenced the results. Those caveats matter for how the findings should be read. The study demonstrates that a short, structured CTG course was associated with large improvements in observed competencies that persisted at three months among this group of Saudi maternity staff—it does not establish that such training reduces birth complications or improves neonatal health.

Causal and clinical interpretations therefore warrant caution, and the authors explicitly call for that restraint. Nevertheless, the scale of the effect is notable for a program requiring barely three hours of instruction per participant. For now, the study offers measured evidence that targeted education can move the needle on the observed skills that intrapartum fetal monitoring depends on, while leaving open the question of whether such gains translate into better outcomes for mothers and babies.

Subject of Research: Effect of structured cardiotocography training on fetal monitoring skills among maternity nurses and midwives

Article Title: Effectiveness of structured cardiotocography training on practical performance and fetal trace interpretation among maternity nurses and midwives: a quasi-experimental controlled study

Article References: Alhariqi, H. M., Fadel, E. A., & Elsayed, H. E. M. (2026). Effectiveness of structured cardiotocography training on practical performance and fetal trace interpretation among maternity nurses and midwives: a quasi-experimental controlled study. BMC Nursing. https://doi.org/10.1186/s12912-026-05503-0

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05503-0

Keywords: cardiotocography, fetal heart rate monitoring, midwives, maternity nurses, training program, quasi-experimental study, competency-based education, fetal trace interpretation, intrapartum care, Saudi Arabia, nursing education, Effectiveness