Antenatal cardiotocography for fetal assessment

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dc.contributor.authorGrivell, R.
dc.contributor.authorAlfirevic, Z.
dc.contributor.authorGyte, G.
dc.contributor.authorDevane, D.
dc.contributor.editorGrivell, R.M.
dc.date.issued2012
dc.description.abstractBACKGROUND 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 (9 July 2012) 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 eligibility, quality and extracted data. 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) 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) nor in the 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). 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) 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.
dc.description.statementofresponsibilityRosalie M Grivell, Zarko Alfirevic, Gillian ML Gyte, Declan Devane
dc.identifier.citationCochrane Database of Systematic Reviews, 2012; 12(12):1-35
dc.identifier.doi10.1002/14651858.CD007863.pub3
dc.identifier.issn1469-493X
dc.identifier.issn1469-493X
dc.identifier.orcidGrivell, R. [0000-0002-2447-6519]
dc.identifier.urihttp://hdl.handle.net/2440/76959
dc.language.isoen
dc.publisherUpdate Software Ltd
dc.rights© 2012 The Cochrane Collaboration.
dc.source.urihttps://doi.org/10.1002/14651858.cd007863.pub3
dc.subjectHumans
dc.subjectDiagnosis, Computer-Assisted
dc.subjectCardiotocography
dc.subjectPregnancy
dc.subjectFemale
dc.subjectRandomized Controlled Trials as Topic
dc.subjectPerinatal Mortality
dc.titleAntenatal cardiotocography for fetal assessment
dc.typeJournal article
pubs.publication-statusPublished

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