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Table 9 Impact of antepartum cardiotocography on stillbirth and perinatal outcomes

From: Reducing stillbirths: screening and monitoring during pregnancy and labour

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)