Randomised controlled trial of cardiotocography versus Doppler auscultation of fetal heart at admission in labour in low risk obstetric population.
OBJECTIVE
To compare the effect of admission cardiotocography and Doppler auscultation of the fetal heart on neonatal outcome and levels of obstetric intervention in a low risk obstetric population.


METHODS
Randomised controlled trial.


METHODS
Obstetric unit of teaching hospital


METHODS
Pregnant women who had no obstetric complications that warranted continuous monitoring of fetal heart rate in labour.


METHODS
Women were randomised to receive either cardiotocography or Doppler auscultation of the fetal heart when they were admitted in spontaneous uncomplicated labour.


METHODS
The primary outcome measure was umbilical arterial metabolic acidosis. Secondary outcome measures included other measures of condition at birth and obstetric intervention.


RESULTS
There were no significant differences in the incidence of metabolic acidosis or any other measure of neonatal outcome among women who remained at low risk when they were admitted in labour. However, compared with women who received Doppler auscultation, women who had admission cardiotocography were significantly more likely to have continuous fetal heart rate monitoring in labour (odds ratio 1.49, 95% confidence interval 1.26 to 1.76), augmentation of labour (1.26, 1.02 to 1.56), epidural analgesia (1.33, 1.10 to 1.61), and operative delivery (1.36, 1.12 to 1.65).


CONCLUSIONS
Compared with Doppler auscultation of the fetal heart, admission cardiotocography does not benefit neonatal outcome in low risk women. Its use results in increased obstetric intervention, including operative delivery.
Mires
G
G
Department of Obstetrics and Gynaecology, Ninewells Hospital and Medical School, Dundee, Tayside DD1 9SY. g.j.mires@dundee.ac.uk
Williams
F
F
Howie
P
P
D000138:Acidosis / Q000175:diagnosis*; D015360:Analgesia, Epidural; D001034:Apgar Score; D001784:Blood Gas Analysis; D015148:Cardiotocography; D002585:Cesarean Section; D005260:Female; D006340:Heart Rate, Fetal; D006801:Humans; D015931:Intensive Care, Neonatal; D011175:Positive-Pressure Respiration; D011247:Pregnancy; D012307:Risk Factors; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D019564:Unnecessary Procedures