Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing

Use of the admission cardiotocograph (CTG) for low-risk women on admission in labour appears not to be effective compared with intermittent auscultation.

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

Summary

A Cochrane review 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 (CTG) had a higher probability of an increase in incidence of caesarean section than women allocated to intermittent auscultation (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 admission CTG 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 intermittent auscultation. There were no differences between groups in other secondary outcome measures.

Clinical comments

Ədəbiyyat

1. 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. .