• About Us
    • Contact Us
    • Login
    • ObGFirst
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • COVID-19
About Us Contact Us Login ObGFirst
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • COVID-19
Grand Rounds

Results from the ADCAR trial: Intermittent Auscultation vs Admission Cardiotocography

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • Smith et al. (BJOG, 2018) assessed the effect of intermittent auscultation vs admission cardiotocography on cesarean section rates

METHODS:

  • Parallel assignment multicenter randomized trial (RCT)
    • Admission Cardiotocography versus intermittent Auscultation of the foetal heart Rate (ADCAR) trial
  • Participants
    • Healthy, low-risk pregnant women
    • >18 years, at term (37w0d to 40w6d)
    • Signs and symptoms of possible labor onset on admission to L&D
  • Exposures
    • Intermittent auscultation: Included abdominal palpation of uterine contractions and assessment of the FHR for ≥60 seconds after a uterine contraction
    • 20 minutes of admission cardiotocography
  • During labor
    • First stage of labor: Intermittent auscultation for 1 minute at least every 15 minutes
    • Second stage: Intermittent auscultation for 1 minute every 5 minutes in the second stage of labor or conversion to continuous electronic fetal monitoring (EFM) if clinically indicated
  • Primary outcome
    • Cesarean section
  • Secondary outcomes
    • Obstetric interventions (e.g., continuous EFM during labor, fetal blood sampling, augmentation of labor)
    • Neonatal morbidity (e.g., metabolic acidosis, admission to the neonatal intensive care unit, neonatal death)

RESULTS:

  • 3,034 women were included
    • 1,513 in intermittent auscultation group | 1,521 in admission cardiotocography group
  • There was no statistical difference in cesarean section rates
    • Intermittent auscultation group: 8.6%
    • Admission cardiotocography group: 6.9%
    • Relative risk (RR) 1.24 (95% CI, 0.97 to 1.58)
  • The use of continuous EFM during labor was lower in the intermittent auscultation group
    • Intermittent auscultation group: 72% | Admission cardiotocography group: 86%
    • Relative risk (RR) 0.90 (95% CI, 0.86 to 0.93; P<0.00001)
  • No statistical differences were noted in other secondary outcomes

CONCLUSION:

  • There is a higher risk of continuous electronic fetal monitoring when women undergo admission cardiotocography vs intermittent auscultation at the time of admission to L&D
  • Otherwise, no differences between admission cardiotocography vs intermittent auscultation was noted

Learn More – Primary Sources:

Admission cardiotocography versus intermittent auscultation of the fetal heart in low‐risk pregnancy during evaluation for possible labour admission – a multicentre randomised trial: the ADCAR trial

Now You Can Get ObG Clinical Research Summaries Direct to Your Phone, with ObGFirst

Learn More  »

image_pdfFavoriteLoadingFavorite
< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

Electronic Fetal Monitoring vs. Intermittent Auscultation
Is the Use of Beta-blockers in Pregnancy Related to Fetal Cardiac Anomalies?
Which Fetal Heart Monitoring Parameters Best Predict Fetal Acidemia?

Sections

  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • COVID-19

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site