Labor Admission Test Research Articles

Study of labour admission test and amniotic fluid index in term high risk pregnancy and their association with labour and perinatal outcome

Study of labour admission test and amniotic fluid index in term high risk pregnancy and their association with labour and perinatal outcome

A cross-sectional study on role of labor admission test by CTG as a predictor of perinatal outcome

A cross-sectional study on role of labor admission test by CTG as a predictor of perinatal outcome

Efficacy of admission cardiotocography on neonatal outcome in term pregnancy admitted in labor in a rural-based tertiary care center: A prospective study

Background: Cardiotocography (CTG) is first-line investigation for antepartum and intrapartum fetal assessment. Fetal monitoring during labor helps identifying fetuses at risk of hypoxic damage and helps institute appropriate intervention to optimize perinatal outcome and prevent neurological injuries. Aims and Objectives: The present study was conducted to evaluate the efficacy of CTG on neonatal outcome and levels of obstetric intervention in term pregnancy admitted in labor. Materials and Methods: The prospective study was conducted in Bankura Sammilani Medical College and Hospital during June 2019–December 2020 among 180 pregnant women in term having no obstetric complications that warranted continuous monitoring of fetal heart rate admitted in labor. Principles of descriptive statistics were used. Results: The mothers were classified into three groups such as labor admission test (LAT) reactive, LAT suspicious, and LAT pathological. Majority of the mothers were aged <20 years, nullipara, primigravida, having clear liquor, which underwent emergency LUCS. About 35% mothers were carrying fetus having distress. The newborns of almost 44% mothers were admitted in NICU. The sensitivity of admission CTG to detect intrapartum fetal distress is 84.13%, specificity is 67.52%, positive predictive value is 58.24%, and negative predictive value is 88.76%. Conclusion: Admission CTG does not benefit the neonatal outcome in normal- or low-risk women and rather results in increased obstetric intervention.

Clinical study on maternal and perinatal outcomes in low risk and high women with respect to labour admission test

Clinical study on maternal and perinatal outcomes in low risk and high women with respect to labour admission test

Labour Admission Test - A low cost alternative to predict foetal distress and neonatal outcomes

Background and Objectives: The aim of various antepartum and intrapartum monitoring methods is to detect foetal hypoxia at the earliest and to prevent subsequent damage. Cardiotocography (CTG) is one of them. Routine and continuous EFM in labour is not possible in developing countries with limited resources and manpower. Objective of the study was to evaluate the role of CTG as admission test (AT) to predict foetal outcome in low and high-risk group. Methods: The study population consisted of 100 low risk and 100 high risk patients at term in labour admitted at WCH Hospital attached to J.J.M Medical College, Davangere. Patients were subjected to admission CTG for 20 minutes. The trace thus obtained was classified as normal, suspicious and pathological AT as per NICE 2017 Guidelines on Intrapartum Care. Results: Among the study group of 200 cases, including low and high-risk groups, 156 (95 & 61) cases had normal AT, 29 (5 & 24) cases had suspicious and 15 high risk cases had Pathological AT. The incidence of foetal distress, caesarean rate, Apgar score at 5 minutes less than 7, NICU admission was higher in pathological AT group than in normal AT. A statistical analysis comparing normal and abnormal (suspicious + pathological) AT showed high specificity 83.82% and high negative predictive value 92.95%. However, LAT was found to have low sensitivity 59.26% and low positive predictive value 36.36%. Conclusion: CTG as LAT is a simple, non-invasive, low cost test with high specificity and NP, that can be used to triage patients at the outset, thereby utilizing the limited equipment and staff effectively in resource poor labour wards. Keywords: Labour Admission Test, Cardiotocography, Perinatal Outcome, Electronic Fetal Monitoring

Labour admission test: A screening test for foetal distress in labour

Labour admission test: A screening test for foetal distress in labour

Clinical efficacy and reliability of amniotic fluid index (AFI) as labour admission test in correlation to perinatal outcome

Clinical efficacy and reliability of amniotic fluid index (AFI) as labour admission test in correlation to perinatal outcome

A Retrospective Study on Correlation of Labour Admission Test with Perinatal outcome and Mode of Delivery

A Retrospective Study on Correlation of Labour Admission Test with Perinatal outcome and Mode of Delivery

Admission Cardiotocography: A Predictor of Neonatal Outcome.

Screening for fetal distress is a big challenge for obstetricians. Labor admission test by cardiotocography (CTG) can be utilized to differentiate between mothers, in whom continuous fetal monitoring is needed and those who can be managed by intermittent auscultation. Admission CTG is commonly used screening test which aims to identify on admission to the delivery unit the fetus at increased risk of intrapartum hypoxia. We conducted a study to evaluate the efficacy of CTG in low- and high-risk women. A prospective longitudinal study was conducted on 200 low-risk and high-risk antenatal women, beyond 32-week gestation with live pregnancy in labor and admitted in labor ward. Correlation of labor admission test with meconium in low risk and high risk was found statistically significant (p=0.0010 and p=0.000046, respectively). Correlation of labor admission test with low Apgar score, NICU admission and mortality was found statistically insignificant in low-risk and high-risk groups. Admission CTG does not benefit the neonatal outcome in normal- or low-risk women and rather results in increased obstetric intervention. Thus, it is not beneficial as a screening test to detect intrapartum fetal distress in normal- or low-risk women.

Reply: Admission cardiotocography: practice based on evidence or assumptions and untested theories?

I thank Pelle Lindqvist for his interest in my commentary 1. The commentary 2 evaluated admission cardiotocography (CTG) from the perspective of clinical epidemiology – this is a part of evidence-based medicine. Lindqvist refers to his own experience, assumptions and untested theories indicating that admission CTG in all women improves outcomes in high-risk pregnancies. It is well known that it is difficult to draw conclusions from experiences on serious outcomes with very low frequencies. The subjective risk estimation is usually much higher than the objective (or epidemiological) risk estimation 3. When there is disagreement about which procedures or treatments are best, it is important to have academic discussions about the topic and to review the research literature carefully. Today the evidence is interpreted differently, as the test is recommended for all women in Finland and Sweden, but only for high-risk women in Denmark, Iceland and Norway. In Great Britain, where the traditions for making evidence-based guidelines are stronger than in the Nordic countries, the guidelines for intrapartum care among healthy women do not recommend admission CTG in low-risk women 4. In my view, the current evidence does not support routine use in low-risk women. It is possible that future research will provide other results but until then we should base our practice on evidence, not assumptions. As to the specific points in Pelle Lindqvist′s letter: The correct definition is of course that the admission CTG was introduced as a screening for fetal distress in labor, as defined by Ingemarsson et al. in 1986 5. Pelle Lindqvist states that admission CTG has never been used to predict later outcome. This is incorrect, and he is obviously not aware of the history on how and why the test was introduced 5. He also states that the commentary does not address perinatal mortality and serious morbidity. This, again, must rely on a misunderstanding. These important issues are addressed, as is the risk of type II errors because of insufficient sample size. The comment about skills in interpreting CTG-tracings was already discussed in a previous author reply 6. Pelle Lindqvist seems to imply that the labor admission test plays an important role in detecting cases of intrauterine fetal deaths (IUFD) upon admission to the hospital. I strongly disagree. If the midwife suspects IUFD after auscultation, the woman should have an ultrasound examination to verify the diagnosis, not a CTG.

Amniotic fluid index at admission in labour as predictor of intrapartum fetal status

SummaryTo re-examine the value of amniotic fluid index at admission in labour (aAFI) as a predictor of intrapartum fetal status, in 326 term pregnancies at their admission in labour, labour admission test (LAT) and antepartum risk status were recorded. The different categories were correlated with fetal/neonatal outcome. There were 68.7% women at low risk on the Minnesota scale for antepartum status. The proportion of women with low aAFI (≤5 cm) was higher in the high-risk group (8 of 12, 64%, p = 0.0001) and occurrence of significantly higher non-reassuring fetal status (NRFS; 10 of 12 with low AFI, 83%, p = 0.0001). Number recording LAT as non-reactive trace (41 cases) was similar irrespective of the pregnancy status (24 and 17 in low- and high-risk cases, respectively) and fetal status through labour (21 and 20 in fetuses with NRFS and otherwise, respectively). Negative predictive value was similar between the groups (88% for aAFI and 89% for LAT), and LAT was found to be more specific (91%) than 64% for aAFI. Sensitivity and positive predictive values were poor in both. It is concluded that aAFI is not a reliable screening test to predict intrapartum fetal compromise.

Labor Admission Test

ABSTRACT Labor admission test (LAT) is performed at the onset of labor to establish fetal well-being in low-risk pregnancies and identify those fetuses who either may be hypoxic, needing delivery or at risk of developing hypoxia during labor so that additional measures of fetal surveillance can be instituted to prevent adverse outcomes. We searched the literature in Medline, Cochrane Library and PubMed using the words— cardiotocograph, cardiotocogram, nonstress test, vibroacoustic stimulus (VAS), amniotic fluid index (AFI), Doppler, labor admission test, labor admission cardiotocography (CTG) and reviewed four randomized controlled trials (RCTs) and three systematic reviews to summarize the current evidence regarding use of LAT. Although the existing RCTs and systematic reviews do not favor admission testing, we have critically reviewed the methodology used in some of these major studies. There is a need for robust RCTs with adequate sample size to evaluate the effectiveness of LAT. In clinical practice, while a normal admission CTG reassures the mother and the clinician about the health of the baby, an admission CTG with nonreassuring FHR pattern leads to careful review which may reveal a growth restricted or compromised fetus before onset of active labor when the risk of fetal hypoxia is higher with increasing frequency and duration of uterine contractions. Like in other obstetric interventions, the woman should be offered the choice of LAT after providing appropriate information and her informed decision should be respected.

Norwegian midwives’ perception of the labour admission test

To explore what information and knowledge the labour admission test is perceived to provide and what meaning the test carries in the daily work of practising midwives. In-depth interviews transcribed verbatim and analysed using the grounded theory technique. Four different labour wards in Norway. A theoretical sample of 12 practising midwives. The core category "experiencing contradictions" was identified during the analyses, indicating that the midwives found conflicting interests within themselves, or between themselves and others when using the labour admission test. They experienced contradictions between professional identity and the increasing use of technology, between feeling safe and feeling unsafe and between having power and being powerless. The labour admission traces could be difficult to interpret, especially for newly qualified midwives. Some midwives thought that a labour admission trace could protect them in case of litigation. The hierarchy of power in the labour ward influences the use and interpretation of the labour admission test. Some midwives felt their professional identity threatened and that midwives in general are losing their traditional skills because of the increasing use of obstetric technology. The findings of the present study should be taken into consideration when changing practice to not routinely perform the labour admission test. There is also a need for further research on what effect the increasing use of obstetric technology has on traditional midwifery skills.

Prognostic value of the labour admission test and its effectiveness compared with auscultation only: a systematic review

To assess the effectiveness of the labour admission test in preventing adverse outcomes, compared with auscultation only, and to assess the test's prognostic value in predicting adverse outcomes. Systematic review. Labour wards in hospitals. Pregnant women in labour. Three randomised controlled trials including 11,259 women and 11 observational studies including 5831 women. Literature searches in Medline, EMBASE, CINAHL, SweMed, The Cochrane Central Register of Controlled Trials, reference lists from identified studies and contact with experts. Obstetric interventions (augmentation of labour, continuous electronic fetal monitoring, epidural analgesia, fetal blood sampling and operative deliveries) and neonatal outcomes (perinatal mortality, Apgar score, seizures, resuscitation and admission to neonatal unit). Meta-analyses of the controlled trials found that women randomised to the labour admission test were more likely to have minor obstetric interventions like epidural analgesia [relative risk (RR) 1.2, 95% confidence interval (95% CI) 1.1-1.4], continuous electronic fetal monitoring (RR 1.3, 95% CI 1.2-1.5) and fetal blood sampling (RR 1.3, 95% CI 1.1-1.5) compared with women randomised to auscultation on admission. There were no significant differences in any of the other outcomes. From the observational studies, prognostic value for various outcomes was found to be generally poor. Likelihood ratio (LR) for a positive test was above 10 in 2 of 28 single outcomes and between 5 and 10 in six outcomes. There is no evidence supporting that the labour admission test is beneficial in low risk women.

Interobserver agreements in assessing 549 labor admission tests after a standardized training program

The labor admission test is a short cardiotocography (CTG) performed upon admission to the maternity ward. The aim of the present study is to examine interobserver agreements when the labor admission tests were assessed by midwives and obstetricians who had received training in interpreting CTG. Five hundred forty-nine high- and low-risk women who delivered at Hammer-fest Hospital were included. The tests were assessed by three midwives and three obstetricians who had completed a standardized training program. The traces were assessed as normal, intermediary, or abnormal. Weighted kappa (kappaw), proportion of agreement (Pa), and predictive values were calculated. Between the pairs of observers, kappaw varied between 0.57 and 0.75; Pa for a normal test between 0.78 and 0.88, and Pa for an intermediary/abnormal test between 0.56 and 0.69. At a cutoff intermediary test, mean sensitivity was 0.43 (range=0.39 -- 0.48), specificity 0.75 (range=0.69 - 0.81, positive predictive value 0.13 (range=0.12 -- 0.15), negative predictive value 0.94 (range=0.94 -- 0.94), likelihood ratio (LR) for a positive test result 1.73 (range=1.53--1.99), and LR for a negative test result 0.76 (range=0.75--0.77). Midwives and obstetricians who had completed the training program achieved good levels of agreements in assessing labor admission tests. The agreements in normal tests were better than those in intermediary/abnormal tests. Obstetric staff should be aware that there are disagreements in assessing labor admission tests; especially in tests assessed as intermediary/abnormal.

Inter-observer Variation in Assessment of 845 Labor Admission Tests: Comparison Between Midwives and Obstetricians in the Clinical Setting and Two Experts

The labor admission tests entails 20-30 minutes of cardiotocographic (CTG) recording on entry to the maternity ward. Because observer variability reflects the reliability of any clinical test, this study was done to determine the degree of agreement between midwives and obstetricians in evaluating labor admission tests. Two expert consultant obstetricians from other centers also participated. The study group included 845 high- and low-risk women who were admitted in labor and gave birth within 24 hours of the test. Test findings were rated as reactive, equivocal, or ominous. The kappa (κ) value is the difference between observed and expected agreement, or the proportion of potential agreement beyond change. Values exceeding 0.75 reflect excellent agreement, and values between 0.4 and 0.75 reflect fair to good agreement. Weighted kappa (κW) was used in this analysis. The proportion of agreement (Pa) also was calculated. Agreement between the two experts was κw 0.38; Pa for a reactive labor admission test, 0.86; and Pa for an equivocal or ominous test, 0.33. The respective values for agreement between one expert and midwives/obstetricians were 0.25, 0.89, and 0.18. For the other expert, the respective figures were 0.28, 0.85, and 0.20. Nearly 6% of newborn infants had fetal distress. At a cutoff of an equivocal test, sensitivity values for the 2 expert observers were 0.22 and 0.31. Positive predictive values were 0.13 and 0.11. The likelihood ratios for a positive test were 2.3 and 1.92, and for a negative test, 0.86 and 0.83. Despite little evidence that it is beneficial, labor admission testing remains routine practice in most obstetrical units in the Western world. The present findings should prompt reconsideration of this practice, and they suggest the relevance of educational programs for maternity ward staff so that they will more accurately interpret CTG recordings.

Inter‐observer variation in assessment of 845 labour admission tests: comparison between midwives and obstetricians in the clinical setting and two experts

To assess the inter-observer agreement in assessment of the labour admission test between midwives and obstetricians in the clinical setting and two experts in the non-clinical setting, the inter-observer agreement between two experts in the non-clinical setting and to what degree fetal distress in labour could be predicted by the two experts. Observational study. The maternity unit of Hammerfest Hospital, Norway. Eight hundred and forty-five high and low risk women. The labour admission test was first assessed by the midwife or obstetrician in the clinical setting, and was later assessed by two experts. The traces were assessed as normal, equivocal or ominous. Weighted kappa (kappaw), proportion of agreement (Pa) and predictive values were calculated. Weighted kappa, proportion of agreement, sensitivity, positive predictive value and likelihood ratios. Inter-observer agreement between Expert 1 and Expert 2: kappaw 0.38 (CI 0.31-0.46), Pa for reactive labour admission test 0.86 (CI 0.83-0.88) and Pa for equivocal/ominous test 0.33 (CI 0.26-0.40). Agreement between Expert 1 and midwives/obstetricians: kappaw 0.25 (CI 0.15-0.36), Pa for reactive labour admission test 0.89 (CI 0.87-0.91) and Pa for equivocal/ominous labour admission test 0.18 (CI 0.11-0.25). Agreement between Expert 2 and midwives/obstetricians: kappaw 0.28 (CI 0.20-0.37), Pa for reactive labour admission test 0.85 (CI 0.82-0.88) and Pa for equivocal/ominous test 0.20 (CI 0.14-0.26). Totally 5.9% of the newborns had fetal distress. At cutoff equivocal test, sensitivity was 0.22 and 0.31 in the two observers. Positive predictive values were 0.13 and 0.11. Likelihood ratio for a positive test was 2.30 and 1.92 and likelihood ratio for a negative test 0.86 and 0.83. A labour admission test is still routine practice in most obstetric units in the Western world when there is little evidence on its benefits. The results from this study may provide some reconsideration for such practice, and for more research.

Inter-observer variation in assessment of 845 labour admission tests: comparison between midwives and obstetricians in the clinical setting and two experts

Objective To assess the inter-observer agreement in assessment of the labour admission test between midwives and obstetricians in the clinical setting and two experts in the non-clinical setting, the inter-observer agreement between two experts in the non-clinical setting and to what degree fetal distress in labour could be predicted by the two experts. Design Observational study. Setting The maternity unit of Hammerfest Hospital, Norway. Population Eight hundred and forty-five high and low risk women. Method The labour admission test was first assessed by the midwife or obstetrician in the clinical setting, and was later assessed by two experts. The traces were assessed as normal, equivocal or ominous. Weighted kappa (κw), proportion of agreement (Pa) and predictive values were calculated. Main outcome measures Weighted kappa, proportion of agreement, sensitivity, positive predictive value and likelihood ratios. Results Inter-observer agreement between Expert 1 and Expert 2: κw 0.38 (CI 0.31–0.46), Pa for reactive labour admission test 0.86 (CI 0.83–0.88) and Pa for equivocal/ominous test 0.33 (CI 0.26–0.40). Agreement between Expert 1 and midwives/obstetricians: κw 0.25 (CI 0.15–0.36), Pa for reactive labour admission test 0.89 (CI 0.87–0.91) and Pa for equivocal/ominous labour admission test 0.18 (CI 0.11–0.25). Agreement between Expert 2 and midwives/obstetricians: κw 0.28 (CI 0.20–0.37), Pa for reactive labour admission test 0.85 (CI 0.82–0.88) and Pa for equivocal/ominous test 0.20 (CI 0.14–0.26). Totally 5.9% of the newborns had fetal distress. At cutoff equivocal test, sensitivity was 0.22 and 0.31 in the two observers. Positive predictive values were 0.13 and 0.11. Likelihood ratio for a positive test was 2.30 and 1.92 and likelihood ratio for a negative test 0.86 and 0.83. Conclusion A labour admission test is still routine practice in most obstetric units in the Western world when there is little evidence on its benefits. The results from this study may provide some reconsideration for such practice, and for more research.

653 Screening for fetal distress in labor using computer analysis of FHR records as labor admission test

653 Screening for fetal distress in labor using computer analysis of FHR records as labor admission test

Labor admission test: an assessment of the test's value as screening for fetal distress in labor

Labor admission test: an assessment of the test's value as screening for fetal distress in labor