Cardiotocography in early labour: a screening test for predicting fetal outcome

Vinothini Anandabaskar, Hiremath P. B., Sanjeevkumar B., Nivedhana Arthi, Rathnapratheep R.


Background: Fetal surveillance during labour is important to ensure delivery of a healthy baby with minimum intervention. Various parameters can be used to assess the fetal wellbeing like fetal movements perceived by the mother and monitoring of fetal heart rate. The objective of this study is to evaluate the efficacy of cardiotocography in early labour in predicting fetal outcome.

Methods: A prospective hospital based cross sectional study was conducted on a total of 160 antenatal women in early labour with gestational age ≥ 37 weeks of gestation. Cardiotocogram was recorded for 20 minutes with the antenatal women in left lateral position. They are followed up till delivery and the mode of delivery of the baby was recorded. After delivery of the baby, the presence of fetal distress was assessed by careful examination of the neonate and colour of liquor.

Results: Among the antenatal women, cardiotocography findings were normal in 74.4%, suspicious in 15% and pathological in 10.6%. The sensitivity of CTG in evaluating fetal outcome was found to be 84.6%, and the specificity was found to be 85.8%. The positive predictive value was 53.7% and the negative predictive value was 96.6%.

Conclusions: Hence from the above study, it is can be concluded that the false positive rate of CTG is higher. Hence CTG cannot be used a sole indicator of fetal hypoxia. But in a resource limited setting, CTG is definitely a good screening test to predict the fetal outcome.


APGAR score, Cardiotocography, Decelerations, Fetal hypoxia, Lower segment caesarean section, Meconium stained liquor

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

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

Evidence-based clinical guideline No.8. The use and interpretation of CTG in intrapartum fetal surveillance.London. RCOG Press, 2001.

WHO. International Statistical Classification of Diseases and Related Health Problems (International Classification of Diseases) (ICD) 10th Revision - Version:2010. Occupational Health. 2010.

Sandhu GS, Raju R, Bhattacharyya TK. Admission cardiotocography screening of high risk obstetric patients. Medical Journal Armed Forces India. 2008;64(1):43-5.

Sarno A, Ahn M, Brar H, Phelan J, Platt L. Intrapartum Doppler velocimetry, amniotic fluid volume, and fetal heart rate as predictors of subsequent fetal distress. I. An initial report. Am J Obstet Gynecol. 1989;161(6 Pt 1):1508.

Ducey J, Guzman E, Schulman H. Value of screening fetal heart rate tracing in the latent phase of labor. J Reprod Med. 1990;35:899-900.

Khandelwal S, Dhanaraj M, Khandelwal A. Admission test as precursor of perinatal outcome: A prospective study. Arch Gynecol Obstet. 2010;282:377-82.

Sharbaf FR, Amjadi N, Alavi A, Akbari S, Forghani F. Normal and indeterminate pattern of fetal cardiotocography in admission test and pregnancy outcome. J Obstetrics Gynaecol Res. 2014;40(3):694-9.

Dellinger EH, Boehm FH, Crane MM. Electronic fetal rate monitoring: Early neonatal outcomes associated with normal rate, fetal stress, and fetal distress. Am J Obs Gynecol. 2000;182:214-20.

Druzin ML, Fox A, Koght E. The relationship of the non stress test to gestational age. Am J Obs Gynecol. 1985;153:386.

Chua S, Arulkumaran S, Kurup A, Anandakumar C, Selemat N, Ratnam SS. Search for the most predictive tests of fetal well-being in early labor. J Perinat Med. 1996;24:199-206.

Elimian A, Lawlor P, Figueroa R, Wiencek V, Garry D, Quirk J. Intrapartum assessment of fetal well-being: Any role for a fetal admission test? J Matern Fetal Neonatal Med. 2003;13:408-13.

Dwarakanath L, Lakshmikantha G, Chaitra SK. Efficacy of admission cardiotocography (admission test) to predict obstetric outcome. J Evolution Medic Dent Sci. 2013;2(5):418-24.

Thimmappa S, Datti SN. Use of Cardiotocogram (CTG) as an Admission Test as a Predictor of Foetal Outcome in Labour in Low Risk Group. J Evolution Medic Dent Sci. 2019;8(38):2911-5.