The association between undetected small-for-gestational age and abnormal admission cardiotocography: A...

To assess the association between undetected small-for-gestational age (SGA) fetuses and abnormal admission cardiotocography (admCTG) in a low-risk population.

An observational study.

Four hospitals in Stockholm-Gotland, Sweden.

A cohort of 127 461 deliveries between 1 February 2012 and 15 June 2020.

This cohort was linked to the Swedish Neonatal Quality Register. Pregnancies were designated as high or low risk at the time of admission to the labour ward according to pre-defined risk measures. SGA was defined as a birthweight at or below the tenth centile and at or below the third centile for gestational age.

The main outcome was the proportion of undetected SGA by admCTG (normal or abnormal). The secondary outcome was a composite severe adverse neonatal outcome for fetuses born less than 6 hours after admission (Apgar score <4 at 5 minutes, hypoxic-ischaemic encephalopathy grade of 2-3, neonatal seizures and neonatal death).

The rate of abnormal admCTG was 4.9%. The proportion of SGA at or below the tenth centile was higher in the abnormal admCTG group than in the normal admCTG group, 18.6% versus 9.7% (odds ratio 2.1, 95% CI 1.9-2.3). Abnormal admCTG and SGA (≤10th) was associated with a more than 20-fold increased risk of an adverse outcome compared with normal admCTG and non-SGA (adjusted odds ratio 23.7, 95% CI 9.8-57.3). The latter had a risk of 1/2000 of an adverse outcome.

In this low-risk population, undetected SGA fetuses were more prone to having abnormal admCTG and had a substantially higher risk of severe adverse neonatal outcomes.