SynthesisCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2021
Effectiveness of intrapartum fetal surveillance to improve maternal and neonatal outcomes: a systematic review and network meta-analysis.
Synthesis in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 49 citations in OpenAlex.
- ST waveform analysis vs cardiotocography alone for intrapartum fetal monitoring: An updated systematic review and meta-analysis of randomized trials.Acta obstetricia et gynecologica Scandinavica · 2024Pooled it
- Review
- Long-term neurological health of the term offspring born via cesarean section for non-reassuring fetal monitoring.Archives of gynecology and obstetrics · 2026Article
- Advancements in Fetal Heart Rate Monitoring: A Report on Opportunities and Strategic Initiatives for Better Intrapartum Care.BJOG : an international journal of obstetrics and gynaecology · 2025Review
- How cesarean section rates can be reduced through an effective financial strategy: A protocol for systematic review.Medicine · 2025Article
- Pathological fetal heart rate tracing patterns and neonatal outcomes among parturients beyond 32 weeks of gestation: a prospective observational study.Archives of gynecology and obstetrics · 2024Observational
- Umbilical cord blood gases sampling in low-risk vaginal deliveries as a predictor of adverse neonatal outcome.Archives of gynecology and obstetrics · 2024Article
- Tending to the machine: The impact of intrapartum fetal surveillance on women in Australia.PloS one · 2024Article
- Perinatal and Neonatal Outcomes Using Cardiotocography Versus STAN and Cardiotocography: a Systematic Review.Maedica · 2023Article
- Computerized cardiotocography analysis during labor - A state-of-the-art review.Acta obstetricia et gynecologica Scandinavica · 2023Review
- Accuracy of intrapartum cardiotocography in identifying acidemia at birth by umbilical cord blood gasometry in high-risk pregnancies.Revista da Associacao Medica Brasileira (1992) · 2023Article
- Unplanned Cesarean for Abnormal or Indeterminate Fetal Heart Tracing Varies Significantly by Race and Ethnicity.Journal of midwifery & women's healthArticle
- Intermittent Auscultation for Intrapartum Fetal Heart Rate Surveillance.Journal of midwifery & women's healthReview
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 7 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCesarean delivery is the most common surgical procedure worldwide. Intrapartum fetal surveillance is routinely offered to improve neonatal outcomes, but the effects of different methods on the risk of emergency cesarean deliveries remains uncertain. We conducted a systematic review and network meta-analysis to evaluate the effectiveness of different types of fetal surveillance.
methodsWe searched MEDLINE, Embase and CENTRAL until June 1, 2020, for randomized trials evaluating any intrapartum fetal surveillance method. We performed a network meta-analysis within a frequentist framework. We assessed the quality and network inconsistency of trials. We reported primarily on intrapartum emergency cesarean deliveries and other secondary maternal and neonatal outcomes using risk ratios (RRs) and 95% confidence intervals (CIs).
resultsWe included 33 trials (118 863 patients) evaluating intermittent auscultation with Pinard stethoscope/handheld Doppler (IA), cardiotocography (CTG), computerized cardiotocography (cCTG), CTG with fetal scalp lactate (CTG-lactate), CTG with fetal scalp pH analysis (CTG-FBS), CTG with fetal pulse oximetry (FPO-CTG), CTG with fetal heart electrocardiogram (CTG-STAN) and their combinations. Intermittent auscultation reduced the risk of emergency cesarean deliveries compared with other types of surveillance (IA v. CTG: RR 0.83, 95% CI 0.72-0.97; IA v. CTG-FBS: RR 0.71, 95% CI 0.63-0.80; IA v.CTG-lactate: RR 0.77, 95% CI 0.64-0.92; IA v. FPO-CTG: RR 0.75, 95% CI 0.65-0.87; IA v.FPO-CTG-FBS: RR 0.81, 95% CI 0.67-0.99; cCTG-FBS v. IA: RR 1.21, 95% CI 1.04-1.42), except STAN-CTG-FBS (RR 1.17, 95% CI 0.98-1.40). There was a similar reduction observed for emergency cesarean deliveries for fetal distress. None of the evaluated methods was associated with a reduced risk of neonatal acidemia, neonatal unit admissions, Apgar scores or perinatal death.
interpretationCompared with other types of fetal surveillance, intermittent auscultation seems to reduce emergency cesarean deliveries in labour without increasing adverse neonatal and maternal outcomes.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.