Revisiting the Value of Admission Cardiotocography in Term Pregnancies: An Updated Systematic Review and Meta-Analysis.
meta_analysis · Level I
Where this comes from
- Record sourced from PubMed, PMID 41074594.
- Also identified by DOI 10.1111/1471-0528.70047 and PMC identifier 12770071.
- Licence recorded as CC BY.
- The licence permits redistribution, so the abstract is shown in full and the full text is available from the publisher.
Abstract
Admission cardiotocography (CTG) remains widely used to assess the fetal condition at the onset of labour in low-risk pregnancies, despite international guidelines recommending against its routine use and advocating intermittent auscultation (IA) instead. To evaluate the effect of admission CTG compared with IA upon admission on maternal and neonatal outcomes in low-risk term pregnancies. PubMed and the Cochrane Library were searched from inception to April 2025. Randomised controlled trials (RCTs) comparing admission CTG with IA in low-risk, term pregnancies with singleton fetuses. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2.0 from the Cochrane Library. Random-effects meta-analysis generated relative risks (RRs), and the quality of the evidence was evaluated using GRADE. Five RCTs (16 341 pregnant women) were included. Admission CTG was associated with significantly higher use of continuous electronic fetal heart rate (FHR) monitoring (RR 1.23, 95% CI: 1.05-1.44, I<sup>2</sup> = 95%). No significant differences were found for caesarean section (RR 1.09, 95% CI: 0.86-1.37, I<sup>2</sup> = 49%), fetal blood sampling (RR 1.16, 95% CI: 0.96-1.40, I<sup>2</sup> = 44%), instrumental deliveries (RR 1.06, 95% CI: 0.90-1.19, I<sup>2</sup> = 38%), neonatal intensive care unit (NICU) admission (RR 1.07, 95% CI: 0.91-1.27, I<sup>2</sup> = 0%), or Apgar score < 7 at 5 min (RR 0.97, 95% CI: 0.62-1.54, I<sup>2</sup> = 13%). Evidence certainty was rated moderate for most outcomes. Routine admission CTG in low-risk term pregnancies demonstrated no improvement in maternal or neonatal outcomes. Previous concerns regarding increased caesarean delivery rates appear overstated. These findings support current recommendations favouring IA over routine admission CTG in low-risk pregnancies. Future research should focus on intermediate-risk populations, standardised implementation and clinically meaningful outcomes. PROSPERO registration number: CRD420251028693.
Medical subject headings
- Cardiotocography
- Patient Admission