Randomised controlled trial of cardiotocography versus Doppler auscultation of fetal heart at admission in labour in low risk obstetric population  Commentary: changes between protocol and manuscript should be declared at submission  Commentary: research governance must focus on research training  Commentary: Approach to power calculations has to be realistic

doi:10.1136/bmj.322.7300.1457

BMJ 2001;322:1457-1462 ( 16 June )

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Randomised controlled trial of cardiotocography versus Doppler auscultation of fetal heart at admission in labour in low risk obstetric population

Editorial by Goddard

Gary Mires, senior lecturer, ^a Fiona Williams, lecturer, ^b Peter Howie, professor. ^a

^a Department of Obstetrics and Gynaecology, Ninewells Hospital and Medical School, Dundee, Tayside DD1 9SY, ^b Department of Epidemiology and Public Health, Ninewells Hospital and Medical School

Correspondence to: G Mires g.j.mires{at}dundee.ac.uk

Objective: To compare the effect of admission cardiotocographyand Doppler auscultation of the fetal heart on neonatal outcomeand levels of obstetric intervention in a low risk obstetricpopulation.
Design: Randomised controlledtrial.
Setting: Obstetric unit of teaching hospital
Participants: Pregnant women who had no obstetric complicationsthat warranted continuous monitoring of fetal heart rate inlabour.
Intervention: Women were randomised to receive either cardiotocographyor Doppler auscultation of the fetal heart when they were admittedin spontaneous uncomplicatedlabour.
Main outcome measures: The primary outcome measure was umbilicalarterial metabolic acidosis. Secondary outcome measures includedother measures of condition at birth and obstetricintervention.
Results: There were no significant differences in theincidence of metabolic acidosis or any other measure of neonataloutcome among women who remained at low risk when they were admittedin labour. However, compared with women who received Doppler auscultation,women who had admission cardiotocography were significantly morelikely to have continuous fetal heart rate monitoring in labour(odds ratio 1.49, 95% confidence interval 1.26 to 1.76), augmentationof labour (1.26, 1.02 to 1.56), epidural analgesia (1.33, 1.10to 1.61), and operative delivery (1.36, 1.12 to 1.65).
Conclusions: Compared with Doppler auscultation of thefetal heart, admission cardiotocography does not benefit neonataloutcome in low risk women. Its use results in increased obstetricintervention, including operativedelivery.

What is already known on this topic
The admission cardiotocogram is a short recording of the fetal heart rate immediately after admission to the labour ward

Opinion varies about its value in identifying a potentially compromised fetus

In low risk women, the incidence of intrapartum fetal compromise is low

What this study adds
Compared with Doppler auscultation of the fetal heart, admission cardiotocography has no benefit on neonatal outcome in low risk women

Admission cardiotocography results in increased obstetric intervention, including operative delivery

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Rapid Responses:

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What do women think?: Hannah Hulme Hunter
bmj.com, 15 Jun 2001 [Full text]
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