Comment: The quality of evidence is downgraded by imprecise results (very low event rates for mortality).
A Cochrane review [Abstract] 1 included 4 studies with a total of 13 000 subjects. All 4 studies included women in labour. Although not statistically significant, low-risk women allocated to admission cardiotocography (ACTG) had a higher probability of an increase in incidence of caesarean section than women allocated to intermittent auscultation (IA) (RR 1.20, 95% CI 1.00 to 1.44, 4 trials; n=11 338). There was no significant difference in instrumental vaginal birth (RR 1.10, 95% CI 0.95 to 1.27; 4 trials, n=11 338) and fetal and neonatal deaths (5/5658 vs 5/5681; RR 1.01, 95% CI 0.30 to 3.47; 4 trials, 11 339 infants).Women allocated to ACTG had, on average, significantly higher rates of continuous electronic fetal monitoring during labour (RR 1.30, 95% CI 1.14 to 1.48; 3 trials, n=10 753) and fetal blood sampling (RR 1.28, 95% CI 1.13 to 1.45; 3 trials, n=10 757) than women allocated to IA. There were no differences between groups in other secondary outcome measures.
A multicentre randomised trial 2 included 3034 women. There was no statistical difference between the groups in caesarean section (8.6% vs 6.9%) for IA and ACTG groups, respectively (RR 1.24; 95% CI 0.97 to 1.58], or in any other outcome except for use of continuous CTG during labour, which was lower in the IA group (RR 0.90, 95% CI 0.86 to 0.93).
Primary/Secondary Keywords