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Evidence summaries

Cardiotocography Versus Intermittent Auscultation of Fetal Heart on Admission to Labour Ward for Assessment of Fetal Wellbeing

There may be no differences in obstetric or neonatal outcomes between intermittent auscultation and admission cardiotocography (CTG) for low-risk women on admission in labour. Level of evidence: "C"

Comment: The quality of evidence is downgraded by imprecise results (very low event rates for mortality).

Summary

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).

Clinical comments

Note

    References

    • Devane D, Lalor JG, Daly S et al. Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing. Cochrane Database Syst Rev 2017;(1):CD005122. [PubMed]
    • Smith V, Begley C, Newell J et al. Admission cardiotocography versus intermittent auscultation of the fetal heart in low-risk pregnancy during evaluation for possible labour admission - a multicentre randomised trial: the ADCAR trial. BJOG 2019;126(1):114-121.[PubMed]

Primary/Secondary Keywords