Admission test cardiotocography in labour as a predictor of foetal outcome in high risk pregnancies

Anvesha Kumar, Purshottam Bantaklal Jaju


Background: Continuous fetal heart monitoring in all pregnant women in labour has gained prominence in obstetric practice in the recent years. The aim of this study was to emphasize on the role of admission cardiotocography (CTG) in labour as a predictor of foetal outcome in high risk pregnancies.

Methods: This was a prospective observational study done on 340 high risk patients admitted in labour with a period of gestation of ≥37 weeks. An admission CTG which consists of a 20-minute recording of FHR and uterine contractions was taken and the foetal outcome was correlated with it. The non-parametric Chi-square test was used for statistical calculations and a p valve of <0.05 was considered to designate statistical significance.

Results: The admission CTG was reactive in 69.4% of all patients, equivocal in 22.2% and pathological in 8.4% of the 340 recruited patients. A total of 37.5% of the patients were post-dated followed by 20.6% of pregnancy incuded hypertensive patients. The neonatal outcomes in terms of fetal distress, meconium stained liquor, NICU admission were considerably higher in pathological test. The specificity of the test was 53.3%, and the negative predictive was    86.49%.

Conclusions: Admission CTG is a simple, useful screening test and serves as a non-invasive tool in forecasting the adverse foetal outcomes in high risk pregnancies.


Cardiotocography (CTG), Foetal outcome, High risk pregnancy

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Whittle MJ, Martin WL.Foetal monitoring in labor. In: Chamberlain G, steer P,editors Turnbull’s obstetrics. London: Churchill Livingstone; 2001.

Gibb D, Arulkumaran S. Oxford: Boston: Butterworth-Heinemann; 1997. The admission test: Clinical scenario Foetal monitoring in practice. pp. 67–72.

Chandraharan E, Sabaratnam A. Electronic foetal heart rate monitoring in current and future practice. J Obstet Gynecol India. 2008;58(2):121-30.

Thackar SB, Struup DF. Continuous electronic heart rate monitoring for foetal assessment during labor. Cochran Database Syst Rev. 2001;(2)CD000063.

Freeman RK, Garite TJ, Nageotte MP, Miller LA. History of fetal monitoring. Fetal heart rate monitoring (Eds: Freeman RK, Garite TJ). William and Wilkins, Baltimore. 1981:1-6.

Lekis S, Loghis C, Parayoto N. Use of antepartum and intrapartum cardiography. Clin Exp Obstet Gynaecol. 1997;24:79-81.

Schifrin BS, Foye G, Amato J, Kates R, MacKenna J. Routine foetal monitoring in the antepartum period. Obstet Gynecol. 1979;54(l):21-5.

Ingemarsson I, Arulkumaran S, Ingemarsson E, Tambyraja RL, Ratnam SS. Admission test: a screening test for fetal distress in labor. Obstet Gynecol. 1986;68(6):800-6.

Ingemarsson I. Electronic fetal monitoring as a screening test. Intrapartum Fetal surveillance. London: Royal College of obstetricians and Gynaec. 1993.

Prentice A, Lind T. Foetal heart rate monitoring in labour—too frequent intervention, too little benefit? Lancet. 1987;2(8572):1375-7.

National Institute for Health and Clinical Excellence, NICE Clinical Guideline 190.1 - Intrapartum Care. Feb, 2017. pp. 10-13.

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

Blix E, Reinar L M, Klovning A, Oian P. Prognostic value of the labor admission test and its effectiveness compared with auscultation only: A systematic review. Br J Obstet Gynaecol. 2005;112(12):1595-604.

Blessy D, K Saraswathi. A study on role of admission CTG as a screening test to predict fetal outcome. Res J Pharm, Biol Chem Sci Obstet Gynaecol. 2014;5(6):295.

Akhavan S, Lak P, Rahimi-Sharbaf F, Mohammadi SR, Shirazi M. Admission Test and Pregnancy Outcome. Iranian J Med Sci. 2017;42(4):362-8.

Rahman H, Prachi R, Sudip D. Reliability of admission cardiotocography in predicting adverse perinatal outcome in low risk obstetric population. Indian Obstet Gynaecol. 2012;2(4).

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.

Sandhu GS, Raju R, Bhattacharyya TK, Shaktivardhan. Admission Cardiotocography Screening of High-Risk Obstetric patients. Medical J Armed Forces India.2008;64(1):43-45.

Das V, Katiyar N, Malik GK. Role of admission test. J Obstet Gynecol Ind. 2001;51(1):48-50

Gourounti K, Sandall J. Admission cardiotocography versus intermittent auscultation of fetal heart rate: effects on neonatal Apgar score, on the rate of caesarean sections and on the rate of instrumental delivery - a systematic review. International J Nursing Studies. 2007;44(6):1029-35.

Libiran MJ, Solis MS, Santos RR, Baga EB. Admission test as predictor of intrauterine fetal asphyxia. Philippine J Obstet Gynecol: Official publication, Philippine Obstet Gynecol Soc. 1999;23(4):143-9.

Panda S, Das A, Nowroz HM, Singh AS. Role of Admission Tests in Predicting Perinatal Outcome: A Prospective Study. J Preg Child Health. 2015;2(171):2.

Khatun A, Khanam NN, Nazir F. Role of Elaborate Cardiotocography (CTG) in Pregnancy Management. Bangabandhu Sheikh Mujib Medical University J. 2009;2(1):18-24.

Bhangdiya S, Dadhe K, Khatod L. Labor admission test (cardiotocography) as intrapartum risk screening test and its efficacy to predict fetal outcome. Int J Rec Trend Sci Technol. 2015;16:459-62.