Revisiting the Value of Admission Cardiotocography in Term Pregnancies: An Updated Systematic Review and Meta-Analysis

Mariana Tome; Aimée A K Lovers; Lawrence Impey; Jane E Hirst; Antoniya Georgieva

doi:10.1111/1471-0528.70047

Revisiting the Value of Admission Cardiotocography in Term Pregnancies: An Updated Systematic Review and Meta-Analysis

BJOG. 2025 Oct 11. doi: 10.1111/1471-0528.70047. Online ahead of print.

Authors

Mariana Tome¹, Aimée A K Lovers², Lawrence Impey¹, Jane E Hirst^{1

3}, Antoniya Georgieva¹

Affiliations

¹ Oxford Labour Monitoring, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.
² Department of Obstetrics and Gynaecology, Amsterdam UMC, Amsterdam, the Netherlands.
³ The George Institute for Global Health, School of Public Health, Imperial College London, London, UK.

PMID: 41074594
DOI: 10.1111/1471-0528.70047

Abstract

Background: 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.

Objective: To evaluate the effect of admission CTG compared with IA upon admission on maternal and neonatal outcomes in low-risk term pregnancies.

Search strategy: PubMed and the Cochrane Library were searched from inception to April 2025.

Selection criteria: Randomised controlled trials (RCTs) comparing admission CTG with IA in low-risk, term pregnancies with singleton fetuses.

Data collection and analysis: 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.

Main results: 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, I² = 95%). No significant differences were found for caesarean section (RR 1.09, 95% CI: 0.86-1.37, I² = 49%), fetal blood sampling (RR 1.16, 95% CI: 0.96-1.40, I² = 44%), instrumental deliveries (RR 1.06, 95% CI: 0.90-1.19, I² = 38%), neonatal intensive care unit (NICU) admission (RR 1.07, 95% CI: 0.91-1.27, I² = 0%), or Apgar score < 7 at 5 min (RR 0.97, 95% CI: 0.62-1.54, I² = 13%). Evidence certainty was rated moderate for most outcomes.

Conclusions: 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.

Trial registration: PROSPERO registration number: CRD420251028693.

Keywords: admission cardiotocography; fetal monitoring; intermittent auscultation; labour; pregnancy; screening test; systematic review.

Publication types

Review