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Meta-Analysis
. 2015 Sep 12;2015(9):CD007863.
doi: 10.1002/14651858.CD007863.pub4.

Antenatal cardiotocography for fetal assessment

Rosalie M Grivell  1 , Zarko Alfirevic, Gillian M L Gyte, Declan Devane
Affiliations
Meta-Analysis

Antenatal cardiotocography for fetal assessment

Rosalie M Grivell et al. Cochrane Database Syst Rev. .

Abstract

Background: Cardiotocography (CTG) is a continuous recording of the fetal heart rate obtained via an ultrasound transducer placed on the mother's abdomen. CTG is widely used in pregnancy as a method of assessing fetal well-being, predominantly in pregnancies with increased risk of complications.

Objectives: To assess the effectiveness of antenatal CTG (both traditional and computerised assessments) in improving outcomes for mothers and babies during and after pregnancy.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (26 June 2015) and reference lists of retrieved studies.

Selection criteria: Randomised and quasi-randomised trials that compared traditional antenatal CTG with no CTG or CTG results concealed; computerised CTG with no CTG or CTG results concealed; and computerised CTG with traditional CTG.

Data collection and analysis: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.

Main results: Six studies (involving 2105 women) are included. Overall, the included studies were not of high quality, and only two had both adequate randomisation sequence generation and allocation concealment. All studies that were able to be included enrolled only women at increased risk of complications.Comparison of traditional CTG versus no CTG showed no significant difference identified in perinatal mortality (risk ratio (RR) 2.05, 95% confidence interval (CI) 0.95 to 4.42, 2.3% versus 1.1%, four studies, N = 1627, low quality evidence) or potentially preventable deaths (RR 2.46, 95% CI 0.96 to 6.30, four studies, N = 1627), though the meta-analysis was underpowered to assess this outcome. Similarly, there was no significant difference identified in caesarean sections (RR 1.06, 95% CI 0.88 to 1.28, 19.7% versus 18.5%, three trials, N = 1279, low quality evidence). There was also no significant difference identified for secondary outcomes related to Apgar scores less than seven at five minutes (RR 0.83, 95% CI 0.37 to 1.88, one trial, N = 396, very low quality evidence); or admission to neonatal special care units or neonatal intensive care units (RR 1.08, 95% CI 0.84 to 1.39, two trials, N = 883, low quality evidence), nor in the other secondary outcomes that were assessed.There were no eligible studies that compared computerised CTG with no CTG.Comparison of computerised CTG versus traditional CTG showed a significant reduction in perinatal mortality with computerised CTG (RR 0.20, 95% CI 0.04 to 0.88, two studies, 0.9% versus 4.2%, 469 women, moderate quality evidence). However, there was no significant difference identified in potentially preventable deaths (RR 0.23, 95% CI 0.04 to 1.29, two studies, N = 469), though the meta-analysis was underpowered to assess this outcome. There was no significant difference identified in caesarean sections (RR 0.87, 95% CI 0.61 to 1.24, 63% versus 72%, one study, N = 59, low quality evidence), Apgar scores less than seven at five minutes (RR 1.31, 95% CI 0.30 to 5.74, two studies, N = 469, very low quality evidence) or in secondary outcomes.

Authors' conclusions: There is no clear evidence that antenatal CTG improves perinatal outcome, but further studies focusing on the use of computerised CTG in specific populations of women with increased risk of complications are warranted.

PubMed Disclaimer

Conflict of interest statement

Declan Devane: none known.

Gill Gyte received royalties from John Wiley & Sons in respect of ‘A Cochrane Pocketbook – Pregnancy and Childbirth’ Hofmeyr GJ et al. 2008. This Cochrane Pocketbook is a Cochrane/Wiley publication.

Zarko Alfirevic: none known.

Rosalie Grivell: none known.

Figures

1
1
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 Traditional antenatal CTG versus no antenatal CTG, Outcome 1 Perinatal mortality.
1.2
1.2. Analysis
Comparison 1 Traditional antenatal CTG versus no antenatal CTG, Outcome 2 Caesarean section.
1.3
1.3. Analysis
Comparison 1 Traditional antenatal CTG versus no antenatal CTG, Outcome 3 Any potentially preventable perinatal deaths.
1.4
1.4. Analysis
Comparison 1 Traditional antenatal CTG versus no antenatal CTG, Outcome 4 Apgar less than 7 at 5 minutes.
1.7
1.7. Analysis
Comparison 1 Traditional antenatal CTG versus no antenatal CTG, Outcome 7 Admission to neonatal special care unit or intensive care unit.
1.12
1.12. Analysis
Comparison 1 Traditional antenatal CTG versus no antenatal CTG, Outcome 12 Gestational age at birth.
1.13
1.13. Analysis
Comparison 1 Traditional antenatal CTG versus no antenatal CTG, Outcome 13 Neonatal seizures (seizures in the neonatal period, either apparent clinically or detected by electroencephalographic recordings).
1.18
1.18. Analysis
Comparison 1 Traditional antenatal CTG versus no antenatal CTG, Outcome 18 Induction of labour.
3.1
3.1. Analysis
Comparison 3 Computerised antenatal CTG versus traditional antenatal CTG, Outcome 1 Perinatal mortality.
3.2
3.2. Analysis
Comparison 3 Computerised antenatal CTG versus traditional antenatal CTG, Outcome 2 Caesarean section.
3.3
3.3. Analysis
Comparison 3 Computerised antenatal CTG versus traditional antenatal CTG, Outcome 3 Any potentially preventable perinatal death.
3.4
3.4. Analysis
Comparison 3 Computerised antenatal CTG versus traditional antenatal CTG, Outcome 4 Apgar less than 7 at 5 minutes.
3.8
3.8. Analysis
Comparison 3 Computerised antenatal CTG versus traditional antenatal CTG, Outcome 8 Length of stay in neonatal special care unit or intensive care unit.
3.12
3.12. Analysis
Comparison 3 Computerised antenatal CTG versus traditional antenatal CTG, Outcome 12 Gestational age at birth.
See this image and copyright information in PMC

Update of

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