Cardiotocography as an Admission Test for Predicting Fetal Outcomes in Low-Risk Pregnant Women in Labour: A Prospective Observational Study

Background: Early identification of fetal distress during labour is crucial for reducing perinatal morbidity and mortality. It has been found that Cardiotocography (CTG) performed at the time of admission to the labour ward is a good rapid screening tool for assessment of fetal well-being even for low-risk pregnancies. The current study aimed to determine the CTG in predicting fetal outcomes among low-risk pregnant women admitted in labour and to determine its association with intrapartum and neonatal outcomes. Material and Methods: This prospective observational study was conducted in 75 low-risk term pregnant females admitted to a tertiary care teaching hospital. CTG was performed at admission for 20 minutes and, based on the findings, was classified as normal, suspicious, or pathological according to standard guidelines. The records were done for maternal and neonatal outcomes, including mode of delivery, meconium-stained liquor, fetal distress, Apgar scores, need for neonatal resuscitation, and NICU admission. Appropriate statistical tests were applied to determine the results. Results: The overall results showed 69.3% had normal CTG, 20% had suspicious CTG values, and 10.7% had Pathological CTG values. Further analysis found CTG was associated with significantly higher rates of cesarean section (50.0% vs. 5.8% in normal CTG; p=0.008), meconium-stained liquor (75.0%; p<0.001). Fetal parameters showed fetal distress (75.0%; p<0.001), low Apgar score at 1 minute (75.0%; p<0.001), low Apgar score at 5 minutes (50.0%; p=0.002), NICU admission (62.5%; p<0.001), and neonatal resuscitation (62.5%; p<0.001). Overall sensitivity of CTG was 78.6%, specificity of 82.0%, positive predictive value of 56.4%, negative predictive value of 92.8%, and overall diagnostic accuracy of 80.0% for predicting adverse fetal outcomes. Conclusion: This study found that admission CTG was a useful screening tool for identifying low-risk pregnant women at increased risk of adverse fetal outcomes. A normal admission CTG is strongly associated with favourable perinatal outcomes, while suspicious and pathological tracings are associated with increased operative delivery and neonatal morbidity. Its high negative predictive value supports its role in early intrapartum risk stratification.