Admission Cardiotocography in Term Pregnancies for Predicting Intrapartum Interventions and Early Neonatal Outcomes: A Systematic Review

Cardiotocography (CTG) is widely applied for intrapartum fetal surveillance to identify early signs of fetal compromise and guide timely intervention. Despite extensive clinical use, uncertainty persists regarding its effectiveness in improving neonatal outcomes, particularly when used routinely at admission in low-risk term pregnancies. This systematic review addresses inconsistencies in existing evidence concerning the predictive value and clinical utility of admission CTG. The objective was to evaluate its association with intrapartum interventions and early neonatal outcomes. A systematic review design was employed, conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 reporting principles where applicable, analysing studies published between 2000 and 2026 across databases including PubMed, Scopus, Cochrane Library, and Web of Science. No prospective protocol registration was undertaken. Eligible studies included randomized controlled trials and cohort, cross-sectional, and observational designs focusing on term pregnancies. Following screening and eligibility assessment, nine primary studies were included in the qualitative synthesis. Data were extracted and synthesized qualitatively due to clinical and methodological heterogeneity, including differences in study design, population risk status, admission CTG classification criteria, sample size, and outcome definitions. Risk-of-bias assessment showed that most included studies had a moderate overall risk of bias, mainly due to selection bias, lack of blinding, variability in CTG interpretation, and inconsistent outcome assessment. The findings indicate that abnormal admission CTG patterns are associated with increased rates of cesarean section, instrumental delivery, low Apgar scores, and higher neonatal intensive care unit (NICU) admissions, while demonstrating variable diagnostic performance. The reported sensitivity and specificity for predicting low Apgar scores were 66.7% and 93.3%, respectively, whereas other outcomes showed poorer sensitivity and positive predictive value despite higher specificity and negative predictive value. Clinical implications highlight the potential for over-intervention influenced by clinical interpretation without proportional neonatal benefit. Admission CTG remains valuable as a screening tool when applied selectively based on risk stratification. The evidence supports cautious interpretation integrated with clinical assessment. Overall, the findings support selective, risk-based use of admission CTG rather than routine implementation in all low-risk term pregnancies.