Intrapartum cardiotocography with and without computer analysis: a systematic review and metaanalysis of randomized controlled trials

Objective: To evaluate whether intrapartum cardiotocography with computer analysis decreases
the incidence of newborn metabolic acidosis or obstetric intervention when compared with visual
analysis through a systematic review with meta-analysis of randomized controlled trials.
Methods: The research was conducted using Medline, Embase, Web of Science, Scopus,
ClinicalTrial.gov, Ovid and Cochrane Library as electronic databases from the inception of each
database to May 2018. Selection criteria included randomized trial evaluating women with cephalic
presentation at term or late preterm term during labor who were randomized to electronic
fetal heart rate monitoring with either computer analysis (i.e. intervention group) or standard
visual analysis (i.e. control group). Trials evaluating antenatal fetal heart rate monitoring in
women not in labor were excluded. The primary outcome was incidence of newborn metabolic
acidosis, defined as pH less than 7.05 and base deficit greater than 12mmol/L. Secondary outcomes
were mode of delivery, admission to neonatal intensive care unit, hypoxic–ischemic
encephalopathy, and perinatal death. The summary measures were reported as relative risk (RR)
with 95% confidence interval (CI).
Results: Three randomized controlled trials (RCTs), including 54,492 participants, which met
inclusion criteria for this meta-analysis, were analyzed. All the included trials enrolled women
with cephalic presentation at term or late preterm. Women were randomized in the active first
stage of labor and all of them received continuous cardiotocography (CTG) from randomization
until delivery. Women who received continuous CTG during labor with computerized analysis
had similar risk of newborn metabolic acidosis. No between group differences were found in
the secondary outcomes.
Conclusions: Compared with visual analysis, use of computer analysis of fetal monitoring signals
during labor did not significantly reduce the rate of metabolic acidosis or obstetric intervention.