Antenatal cardiotocography in dutch primary midwife-led care: Maternal and perinatal outcomes and serious adverse events. A prospective observational cohort study

Elise M. Neppelenbroek, Corine J. M. Verhoeven, Olivier W. H. van der Heijden, Marit S. G. van der Pijl, Carola J. M. Groenen, Wessel Ganzevoort, Bas S. W. A. Nij Bijvank, Ank de Jonge

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Problem: It is yet unknown whether shifting antenatal cardiotocography (aCTG) from obstetrician-led to midwife-led care leads to a safe reduction in referrals. Background: ACTG is used to assess fetal well-being. In the Netherlands, the procedure has until now been performed as part of obstetrician-led care. Developments in E-health facilitates the performance of aCTG outside the hospital in midwife-led care, hereby increasing continuity of care. Aim: To evaluate 1) process outcomes of implementing aCTG for specific indications in primary midwife-led care; 2) maternal and perinatal outcomes of pregnant women receiving aCTG in midwife-led care; 3) serious adverse events (with outcomes, causes, avoidability, and potential prevention strategies) that have occurred during the innovation project ‘aCTG in midwife-led care’. Methods: Prospective observational cohort study and a case series study of serious adverse events. Findings: A total of 1584 pregnant women with a specific aCTG indication were included in this cohort study for whom 1795 aCTGs were performed in midwife-led care. 1591 aCTGs(89.7%) were classified as reassuring. Referral to obstetrician-led care occurred for 234 women(13.0%) after an aCTG in midwife-led care of whom 202(86%) were referred back. Severe neonatal morbidity occurred in 27 neonates (1.7%). In the 5736 aCTGs included in the case series study, one case with a serious neonatal outcome was assessed as a serious adverse event attributable to human factors. Discussion: ACTGs performed in midwife-led care increased continuity of care. In this innovation project, maternal and perinatal outcomes were in the expected range for women in midwife-led care.
Original languageEnglish
JournalWomen and birth
Early online date28 Aug 2023
Publication statusE-pub ahead of print - 28 Aug 2023


  • Antenatal cardiotocography
  • Antepartum fetal monitoring
  • Midwife-led care
  • Task shifting

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