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

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