Table 9

Impact of antepartum cardiotocography on stillbirth and perinatal outcomes

Source

Location and Type of Study

Intervention

Stillbirths/Perinatal Outcomes


Reviews and meta-analyses


Pattison and McCowan 1999 [91]

UK, Australia.

Review (Cochrane). 3 RCTs included (N = 1279).

Compared the impact of electronic fetal monitoring with an antenatal CTG (intervention) vs. a control group where the results of the CTG were withheld from the caregiver or no monitoring was done on perinatal morbidity and mortality and maternal morbidity.

PMR (excluding lethal abnormalities): OR = 2.65 (95% CI: 0.99–7.12) [NS].

[12/651 vs. 4/628 in intervention and control groups, respectively].


Observational studies


Evertson et al. 1978 [90]

USA.

Case series. N = 746 pregnant women undergoing 1119 CSTs.

Assessed the incidence of fetal deaths within one week of a negative CST.

SBR: 7/680 patients (1%) within 1 week of a negative CST.

Fetal death in most cases resulted from factors other then uteroplacental insufficiency (umbilical cord accident, malformations, and placental abruption)


Flynn et al. 1982 [88]

UK.

RCT. Pregnant patients (N = 300) with non-stress antepartum cardiotocography tracings (N = 569; N = 144 intervention, N = 156 controls).

Compared impact on pregnancy outcomes of revealing cardiotocography results to clinician (intervention) vs. concealing results (controls).

SBR+NMR: Significant association with 'non-reactive' traces.

Significant association of nonreactive traces with rates of fetal growth restriction, admission to special care baby unit, Apgar scores at 1 and 5 min.


Freeman et al. 1982 [92]

USA and Canada. 18 institutions.

Comparison of diagnostic tests. Pregnant women (N = 6168; N = 4626 CST, N = 1542 NST) with increased risk for uteroplacental insufficiency.

Compared the impact on fetal outcomes of CST (intervention) vs. NST (comparison) for primary fetal surveillance.

PMR: 8.4/1000 vs. 21.4/1000 in intervention vs. comparison groups, respectively (P < 0.05). After correction for congenital anomalies and unrelated causes: 3.5/1000 vs. 7.1/1000 intervention vs. comparison groups, respectively (P < 0.05).

Fetal death (miscarriage+SB): 1.1/1000 vs. 7.8/1000 in intervention vs. comparison groups, respectively (P < 0.05). After correction: 0.4/1000 vs. 3.2/1000 in intervention vs. comparison groups, respectively (P < 0.05).


Rayburn et al. 1980 [89]

USA (Lexington). University hospital.

Prospective cohort study. High-risk clinic patients (N = 561) who had undergone NST within one week prior to delivery.

Compared the association of reactive vs. non-reactive NSTs vs. no testing with fetal outcomes.

SB: 1/509 in reactive non-stress group (cord accident).

Corrected PMR: 1/509 vs. 2/22 vs. 20/1000 in reactive, non-reactive and no testing groups, respectively (P < 0.05).

Fetal compromise: 4%, 36%, and 13% in reactive, non-reactive and no testing groups, respectively (P < 0.001)


Haws et al. BMC Pregnancy and Childbirth 2009 9(Suppl 1):S5   doi:10.1186/1471-2393-9-S1-S5

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