Reliability of Admission Cardiotocography with and without Amniotic Fluid Index in Predicting Maternal and Fetal Outcomes: A Comparative Observational Study

Background: Intrapartum fetal problems remain an important cause of illness and death around birth, especially in low-resource settings. Admission CTG is commonly used to quickly check fetal well-being, but its ability to predict problems varies. AFI, which reflects placental function and long-term fetal condition, may improve this assessment. Objectives: To assess the reliability of admission CTG alone and CTG+AFI in predicting fetal distress, maternal outcomes, and neonatal outcomes. Methods: This comparative descriptive study was carried out at CSI Kalyani Multispecialty Hospital, Chennai, over two years (October 2012–October 2014). A total of 150 term pregnant women in labour were included and divided into two equal groups: Group I—CTG alone, and Group II—CTG+AFI. CTG tracings were labelled as normal, suspicious, or abnormal. AFI was grouped as oligohydramnios (≤5 cm), borderline (5.1–8 cm), and normal (8.1–20 cm). Outcomes studied were fetal distress, type of delivery, Apgar scores, and need for NICU admission. Results: Normal CTG was seen in most women—88% in Group I and 89.3% in Group II. Oligohydramnios was present in 11% of cases. Abnormal CTG had a strong link with fetal distress (50%), LSCS (100%), and NICU admission (50%). When both CTG and AFI were abnormal, prediction improved further: fetal distress was seen in 75% and NICU admission in 50%. Specificity was high (98%) and NPV was good (91.8%), but sensitivity stayed low (37.5%). Conclusion: Admission CTG is a useful screening tool with high specificity to rule out fetal compromise. Adding AFI improves the ability to predict fetal distress and the need for maternal intervention. However, abnormal CTG or AFI patterns also lead to more operative deliveries without a matching improvement in newborn outcomes. Careful interpretation is needed to avoid unnecessary interventions.