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

Smith, Victoria M.; Begley, Cecily; Newell, J; Higgins, Shane; Murphy, Deirdre J; White, Matthew; Morrison, J.J.; Canny, Siobhan; O’Donovan, D. K.; Devane, Declan

doi:10.1097/01.aoa.0000603792.04514.ef

Cited by 2 publications

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“…A Cochrane report from 2017 17 showed that in a meta‐analysis on 11 338 women, there was a 20% increased rate of caesarean delivery (risk ratio 1.20, 95% CI 1.00–1.44). A subsequent RCT including 3034 deliveries showed no higher risk, but instead showed a lower risk of caesarean delivery in the admCTG group than in the auscultation group (6.9% versus 8.6%, although not statistically significant), 18 hence reducing the previous belief that admCTG increases the risk of caesarean delivery (Figure S3).…”

Section: Discussionmentioning

confidence: 65%

The association between undetected small‐for‐gestational age and abnormal admission cardiotocography: A registry‐based study

Gyllencreutz

Varli

Johansson

et al. 2023

BJOG

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ObjectiveTo assess the association between undetected small‐for‐gestational age (SGA) fetuses and abnormal admission cardiotocography (admCTG) in a low‐risk population.DesignAn observational study.SettingFour hospitals in Stockholm‐Gotland, Sweden.SampleA cohort of 127 461 deliveries between 1 February 2012 and 15 June 2020.MethodsThis cohort was linked to the Swedish Neonatal Quality Register. Pregnancies were designated as high or low risk at the time of admission to the labour ward according to pre‐defined risk measures. SGA was defined as a birthweight at or below the tenth centile and at or below the third centile for gestational age.Main outcome measuresThe main outcome was the proportion of undetected SGA by admCTG (normal or abnormal). The secondary outcome was a composite severe adverse neonatal outcome for fetuses born less than 6 hours after admission (Apgar score <4 at 5 minutes, hypoxic–ischaemic encephalopathy grade of 2–3, neonatal seizures and neonatal death).ResultsThe rate of abnormal admCTG was 4.9%. The proportion of SGA at or below the tenth centile was higher in the abnormal admCTG group than in the normal admCTG group, 18.6% versus 9.7% (odds ratio 2.1, 95% CI 1.9–2.3).Abnormal admCTG and SGA (≤10th) was associated with a more than 20‐fold increased risk of an adverse outcome compared with normal admCTG and non‐SGA (adjusted odds ratio 23.7, 95% CI 9.8–57.3). The latter had a risk of 1/2000 of an adverse outcome.ConclusionsIn this low‐risk population, undetected SGA fetuses were more prone to having abnormal admCTG and had a substantially higher risk of severe adverse neonatal outcomes.

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Section: Discussionmentioning

confidence: 65%

The association between undetected small‐for‐gestational age and abnormal admission cardiotocography: A registry‐based study

Gyllencreutz

Varli

Johansson

et al. 2023

BJOG

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“…Impey et al, 2003 25 , Madaan et al, 2006 26 , Mires et al, 2001 27 , Siristatidis et al, 2012 28 , Smith et al, 2019 29…”

Section: Guidelineunclassified

Fetal Assessment in Pregnancy (Indication and Methodology for Fetal Monitoring in a Low-risk Population). Guideline of the DGGG, DEGUM, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/089, February 2023)

Schiermeier,

von Kaisenberg,

Kehl

et al. 2023

Geburtshilfe Frauenheilkd

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Purpose The aim of this guideline was to find evidence on whether carrying out Doppler examinations and CTGs in low-risk cohorts of pregnant women improves outcomes. Methods First, a systematic search for guidelines was carried out. Identified guidelines were evaluated using the DELPHI instrument of the AWMF. Three guidelines were found to be suitable to evaluate CTG. Two DEGUM best practice guidelines were judged suitable to describe the methods. All studies on this issue were additionally analyzed using 8 PICO questions. A structured consensus of the participating professional societies was achieved using a nominal group process and a structured consensus conference moderated by an independent moderator. Recommendations No antepartum Doppler sonography examinations should be carried out in low-risk cohorts in the context of antenatal care. No antepartum CTG should be carried out in low-risk cohorts. Note The guideline will be published simultaneously in the official journals of both professional societies (i.e., Geburtshilfe und Frauenheilkunde for the DGGG and Ultraschall in der Medizin/European Journal of Ultrasound for the DEGUM).

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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

Cited by 2 publications

References 0 publications

The association between undetected small‐for‐gestational age and abnormal admission cardiotocography: A registry‐based study

The association between undetected small‐for‐gestational age and abnormal admission cardiotocography: A registry‐based study

Fetal Assessment in Pregnancy (Indication and Methodology for Fetal Monitoring in a Low-risk Population). Guideline of the DGGG, DEGUM, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/089, February 2023)

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