Obstetric and Neonatal Outcomes of Women in Labour Undergoing Admission Cardiotocography Versus Intermittent Auscultation at Kenyatta National Hospital: A Randomized Control Trial

Abstract

Background: Admission Cardiotocography (ACTG) is a record of the foetal heart rate for 20 minutes upon admission in labour ward. Assessment of foetal wellbeing throughout labour and delivery is vital for identifying and averting intrapartum foetal compromise. In Low to Middle Income Countries (LMIC) including Kenya there are unproportionate doctor and nurse to patient ratios, as a result labour wards are overcrowded and foetuses at risk of intrapartum hypoxia may be indentified late and interventions instituted late leading to unfavorable neonatal and maternal outcomes that have immense financial, emotional and physical impact. Locally, studies on ACTG and Intermittent Auscultation (IA) are limited despite known shortcomings of IA. To address these aspects of intrapartum foetal monitoring and provide data that could potentially improve the maternal and neonatal outcomes of pregnancy, we aim to fill this gap. Study Objective: To compare obstetric and neonatal outcomes of parturients undergoing ACTG versus IA at the Kenyatta National Hospital (KNH), Kenya. Methodology: This was an open label Randomised Control Trial (RCT) at the KNH labour ward. One hundred (100) Women admitted at KNH for delivery at 37 to 41 completed weeks of gestation were evaluated by taking obstetric and medical history, a general and obstetric exam done and those who matched our inclusion criteria were recruited using two stage randomization. Fifty (50) parturients allotted to the IA arm and 50 ACTG arm. Written consent was obtained from parturients and a structured questionnaire used to collect data on the sociodemographic and reproductive characteristics of participants. Parturients in the ACTG arm underwent ACTG for monitoring of foetal heart rate while those in the IA arm underwent IA. After either ACTG or IA, patients were allowed to proceed to delivery normally and birth outcomes reported after a 24-hour follow-up. The mode of delivery, need for intrapartum interventions and maternal and neonatal outcomes were evaluated. Data analysis was done using version 21 of the Statistical Package for Social Scientist (SPSS). The sociodemographic and reproductive characteristics of women were analysed using Chi square and t-test at 95% CI with a P value <0.05 considered significant. Results 100 women (50 in ACTG arm and 50 IA) were studied. In IA arm, 98% (49/50) of patients had regular foetal heart rate, while 84% (42/50) in ACTG arm had normal findings. About 30% (15/50) and 10% (5/50) of women who underwent ACTG and IG exams delivered by caesarean section, with 1.7 times more women in CTG arm undergoing a CS (P=0.01). The incidence of adverse pregnancy outcomes such as prolonged labour and NRFS did not vary statistically by the type of examination. Apgar scores at five minutes and incidence of NBU and NICU admission of neonates did not vary statistically between the study arms (P>0.05). Conclusions: Routine use of ACTG for low risk parturients does not improve maternal or neonatal outcomes. Key Words: Admission Cardiotocography, Intermittent Auscultation, Labour, Obstetric outcomes, Neonatal outcomes