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

Mkpe Abbey, Kinikanwo I. Green


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.


Admission cardiotocography, Doppler, Fetal heart, High risk, Tertiary health, Nigeria

Full Text:



Ingemarsson I. Electronic fetal monitoring as a screening test. In: Spencer JAD, Ward RHT, eds. Intrapartum fetal surveillance. London: Royal College of Obstetricians and Gynaecologists; 1993: 45-52.

Impey L, Reynolds M, MacQuillan K, Gates S, Murphy J, Sheil O. Admission cardiotocography: a randomised controlled trial. Lancet. 2003;361(9356):465-70.

Penning S, Thomas JG. Management of fetal distress. Obset J Obset gynecol Clin North Am. 1999;26(2):259-74.

Zuspan FP, Quilligam EJ, Iams JD, Geijin HP. Predictor of intrapartum fetal distress:The role of electronic fetal monitoring. Am Journal Obstet Gynecol. 1979;135(3):287-91.

UNICEF. Fact sheet: The state of the world’s children 2016: a fair chance for every child. New York (NY), 2016. Available at: publications/files/UNICEF_SOWC_2016.pdf. Accessed on 19 June 2021.

Danilack VA, Nunes AP, Phipps MG. Unexpected complications of low-risk pregnancies in the United States. Am J Obstet Gynecol. 2015;212(6):809.

National Institute for Health and Care Excellence. Fact sheet: Intrapartum care for healthy women and babies. NICE clinical guideline, 2014. Available at: Accessed on 19 June 2021.

Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, et al. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet. 2016;387(10018):587-603.

Bhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA, Paul VK, et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet. 2014;384(9940):347-70.

WHO recommendation on routine assessment of fetal well-being on labour admission. 15 February 2018.

Thomas J, Kavanagh J, Kelly T. The use of electronic fetal monitoring. Evidence-based clinical guideline, number 8. London: RCOG Press; 2001.

Ayres-de-Campos D, Spong CY, Chandraharan E, FIGO Intrapartum Fetal Monitoring Expert Consensus Panel. FIGO consensus guidelines on intrapartum fetal monitoring: cardiotocography. Int J Gynaecol Obstetr. 2015;131(1):13-24.

Archana T, Kavita NS, Sonal S. Study of admission cardiotocography screening of high risk obstetric cases and its correlation with perinatal outcome. Indian J Obstetr Gynecol Res. 2018;5(2):209-14.

Rahman H, Renjhen P, Dutta S. Reliability of admission cardiotocography for intrapartum monitoring in low resource setting. Niger Med J. 2012;53(3):145-9.

Behuria S, Nayak R. Admission cardiotocography as a screening test in high risk pregnancies and its co-relation with peri-natal outcome. Int J Reprod Contracept Obstet Gynecol. 2016;5(10):3525-8.

Chandraharan E. Intrapartum Fetal Monitoring Guideline. Physiological CTG interpretation. London: Global Academy of Medical Education and Training; 2018.

Charan J, Biswas T. How to calculate sample size for different study designs in medical research. Indian J Psychol Med. 2013;35(2):121-6.

Imaralu JO, Ani FI, Olaleye AO, Sotunsa JO, Akadri A, Adebawojo OO. Patterns of admission cardiotocography decisions and associated perinatal outcomes in a Southern Nigerian teaching hospital. ARRB. 2019;33(2):1-11.

Hajian-Tilaki K. Sample size estimation in epidemiologic studies. Caspian J Intern Med. 2011;2(4):289-98.

Stark M, Zapf A. Sample size calculation and re-estimation based on the prevalence in a single-arm confirmatory diagnostic accuracy study. Stat Methods Med Res. 2020;29(10):2958-71.

Ahmad OB, Boschi-Pinto AC, Lopez AD, Murray CJL, Lozano R, Inoue M. Age standardization of rates: a new WHO standard. GPE discussion paper series: no.31. World Health Organization. 2001.

Howson CP, Kinney MV, Lawn JE. Born too soon: the global action report on preterm birth. Reproduct Health. 2013;10:1.

National Collaborating Centre for Women's and Children's Health (UK). Intrapartum care: care of healthy women and their babies during childbirth. 2007:44-5.