Revisiting the value of admission cardiotocography in term pregnancies: an updated systematic review and meta-analysis
Author(s)
Tome, Mariana
Lovers, Aimée AK
Impey, Lawrence
Hirst, Jane
Georgieva, Antoniya
Type
Journal Article
Abstract
Background
Admission cardiotocography (CTG) remains widely used to assess the fetal condition at the onset of labour in low-risk pregnancies, despite international guidelines recommending against its routine use and advocating intermittent auscultation (IA) instead.
Objective
To evaluate the effect of admission CTG compared with IA upon admission on maternal and neonatal outcomes in low-risk term pregnancies.
Search Strategy
PubMed and the Cochrane Library were searched from inception to April 2025.
Selection Criteria
Randomised controlled trials (RCTs) comparing admission CTG with IA in low-risk, term pregnancies with singleton fetuses.
Data Collection and Analysis
Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2.0 from the Cochrane Library. Random-effects meta-analysis generated relative risks (RRs), and the quality of the evidence was evaluated using GRADE.
Main Results
Five RCTs (16 341 pregnant women) were included. Admission CTG was associated with significantly higher use of continuous electronic fetal heart rate (FHR) monitoring (RR 1.23, 95% CI: 1.05–1.44, I2 = 95%). No significant differences were found for caesarean section (RR 1.09, 95% CI: 0.86–1.37, I2 = 49%), fetal blood sampling (RR 1.16, 95% CI: 0.96–1.40, I2 = 44%), instrumental deliveries (RR 1.06, 95% CI: 0.90–1.19, I2 = 38%), neonatal intensive care unit (NICU) admission (RR 1.07, 95% CI: 0.91–1.27, I2 = 0%), or Apgar score < 7 at 5 min (RR 0.97, 95% CI: 0.62–1.54, I2 = 13%). Evidence certainty was rated moderate for most outcomes.
Conclusions
Routine admission CTG in low-risk term pregnancies demonstrated no improvement in maternal or neonatal outcomes. Previous concerns regarding increased caesarean delivery rates appear overstated. These findings support current recommendations favouring IA over routine admission CTG in low-risk pregnancies. Future research should focus on intermediate-risk populations, standardised implementation and clinically meaningful outcomes.
Trial Registration
PROSPERO registration number: CRD420251028693
Admission cardiotocography (CTG) remains widely used to assess the fetal condition at the onset of labour in low-risk pregnancies, despite international guidelines recommending against its routine use and advocating intermittent auscultation (IA) instead.
Objective
To evaluate the effect of admission CTG compared with IA upon admission on maternal and neonatal outcomes in low-risk term pregnancies.
Search Strategy
PubMed and the Cochrane Library were searched from inception to April 2025.
Selection Criteria
Randomised controlled trials (RCTs) comparing admission CTG with IA in low-risk, term pregnancies with singleton fetuses.
Data Collection and Analysis
Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2.0 from the Cochrane Library. Random-effects meta-analysis generated relative risks (RRs), and the quality of the evidence was evaluated using GRADE.
Main Results
Five RCTs (16 341 pregnant women) were included. Admission CTG was associated with significantly higher use of continuous electronic fetal heart rate (FHR) monitoring (RR 1.23, 95% CI: 1.05–1.44, I2 = 95%). No significant differences were found for caesarean section (RR 1.09, 95% CI: 0.86–1.37, I2 = 49%), fetal blood sampling (RR 1.16, 95% CI: 0.96–1.40, I2 = 44%), instrumental deliveries (RR 1.06, 95% CI: 0.90–1.19, I2 = 38%), neonatal intensive care unit (NICU) admission (RR 1.07, 95% CI: 0.91–1.27, I2 = 0%), or Apgar score < 7 at 5 min (RR 0.97, 95% CI: 0.62–1.54, I2 = 13%). Evidence certainty was rated moderate for most outcomes.
Conclusions
Routine admission CTG in low-risk term pregnancies demonstrated no improvement in maternal or neonatal outcomes. Previous concerns regarding increased caesarean delivery rates appear overstated. These findings support current recommendations favouring IA over routine admission CTG in low-risk pregnancies. Future research should focus on intermediate-risk populations, standardised implementation and clinically meaningful outcomes.
Trial Registration
PROSPERO registration number: CRD420251028693
Date Issued
2026-02-01
Date Acceptance
2025-09-24
Citation
BJOG: An International Journal of Obstetrics and Gynaecology, 2026, 133 (3), pp.375-390
ISSN
1470-0328
Publisher
Wiley
Start Page
375
End Page
390
Journal / Book Title
BJOG: An International Journal of Obstetrics and Gynaecology
Volume
133
Issue
3
Copyright Statement
© 2025 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
License URL
Publication Status
Published
Date Publish Online
2025-10-11