Publication:

Admission cardiotocography versus Doppler auscultation of fetal heart in high risk pregnancies in a tertiary health facility in Nigeria

Background Admission cardiotocography (CTG) and intermittent auscultation (IA) of the fetal heart  might help to identify those foetuses that could not withstand the stress of labour and also predict neonatal outcome. The aim was to compare the associations of admission CTG findings and those of IA of the fetal heart with labour and neonatal outcome.

Methods It was a prospective COHORT study. 30 minutes admission CTG for each of the 387 participants was interpreted, using the FIGO 2015 guideline and physiological interpretation. Admission IA was also performed on the same patients. Women whose CTG showed chronic hypoxia had caesarean section while those with either suspicious or pathological CTG, had intrapartum fetal resuscitation. Those that responded proceeded to labour during which fetal condition was monitored with IA. Data was analysed using a statistical package for social science (SPSS) software, version 19.

Results 108 (28.57%) and 57 (15.08%) of the 378 participants had abnormal admission CTG and admission IA findings respectively. The sensitivity of abnormal admission CTG and IA to predict abnormal IA findings in labour were 70.59% and 41.18% respectively. Compared with admission IA, admission CTG was more likely to predict the following labour and neonatal outcomes: caesarean section rates 72 (70.59%) and 42 (41.18%) for admission CTG versus IA groups respectively; relative risk RR=1.714; 95% CI 1.317-2.231, 1 min Apgar score less than 7, 78 (89.66%) and 36 (41.38%); RR=2.167; 95% CI 1.670-2.810, 5 min Apgar score less than 7, 57 (90.48%) and 33 (52.38%); RR=1.727; 95% CI 1.347-2.215, admission to SCBU 51 (68%) and 30 (40%); RR=1.700; 95% CI 1.237-2.336, intrauterine fetal deaths and early neonatal death.

Conclusions Admission CTG was a better predictor of labour and neonatal outcome than admission IA. CTG was therefore highly recommended as an integral tool in the management of labour.