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

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7300.1457 (Published 16 June 2001) Cite this as: BMJ 2001;322:1457

Abstract

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.

Design: Randomised controlled trial.

Setting: Obstetric unit of teaching hospital

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

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

Main outcome measures: 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.

What is already known on this topic

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

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

Footnotes

    • Accepted 19 February 2001

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

    1. Gary Mires, senior lecturer (g.j.mires{at}dundee.ac.uk)a,
    2. Fiona Williams, lecturerb,
    3. Peter Howie, professora
    1. a Department of Obstetrics and Gynaecology, Ninewells Hospital and Medical School, Dundee, Tayside DD1 9SY
    2. b Department of Epidemiology and Public Health, Ninewells Hospital and Medical School
    3. BMJ, London WC1H 9JR
    4. Department of Community Health Sciences, University of Edinburgh Medical School, Edinburgh EH8 9AG
    5. Department of Obstetrics, Ulleval University Hospital, Oslo, Norway
    1. Correspondence to: G Mires
    • Accepted 19 February 2001

    Abstract

    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.

    Design: Randomised controlled trial.

    Setting: Obstetric unit of teaching hospital

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

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

    Main outcome measures: 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.

    What is already known on this topic

    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

    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

    Footnotes

    • Funding Funding: Chief Scientists Office of the Scottish Executive, Edinburgh.

    • Competing interests None declared

    • Accepted 19 February 2001

    Commentary: changes between protocol and manuscript should be declared at submission

    1. Sandy Goldbeck-Wood, assistant editor (sgoldbeck-wood{at}bmj.com)
    1. a Department of Obstetrics and Gynaecology, Ninewells Hospital and Medical School, Dundee, Tayside DD1 9SY
    2. b Department of Epidemiology and Public Health, Ninewells Hospital and Medical School
    3. BMJ, London WC1H 9JR
    4. Department of Community Health Sciences, University of Edinburgh Medical School, Edinburgh EH8 9AG
    5. Department of Obstetrics, Ulleval University Hospital, Oslo, Norway

      Footnotes

      • Competing interests None declared.

        Commentary: research governance must focus on research training

        1. Gordon D Murray, head of public health sciences (gordon.murray{at}ed.ac.uk)
        1. a Department of Obstetrics and Gynaecology, Ninewells Hospital and Medical School, Dundee, Tayside DD1 9SY
        2. b Department of Epidemiology and Public Health, Ninewells Hospital and Medical School
        3. BMJ, London WC1H 9JR
        4. Department of Community Health Sciences, University of Edinburgh Medical School, Edinburgh EH8 9AG
        5. Department of Obstetrics, Ulleval University Hospital, Oslo, Norway

          Footnotes

          • Competing interests The University of Edinburgh could benefit financially through running courses on research methodology.

            Commentary: Approach to power calculations has to be realistic

            1. Britt-Ingjerd Nesheim, professor (b.i.nesheim{at}ioks.uio.no)
            1. a Department of Obstetrics and Gynaecology, Ninewells Hospital and Medical School, Dundee, Tayside DD1 9SY
            2. b Department of Epidemiology and Public Health, Ninewells Hospital and Medical School
            3. BMJ, London WC1H 9JR
            4. Department of Community Health Sciences, University of Edinburgh Medical School, Edinburgh EH8 9AG
            5. Department of Obstetrics, Ulleval University Hospital, Oslo, Norway

              Footnotes

              • Competing interests None declared.

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