Association between Non-Reactive Cardiotocography and Increasing Caesarean Section Rates: Impact on Neonatal Outcomes

Abstract

Background: The global increase in caesarean section (CS) rates has become a major public health concern, with non-reactive cardiotocography (CTG) frequently identified as a common indication. CTG is widely used for intrapartum fetal monitoring to assess fetal well-being; however, abnormal findings often lead to surgical intervention despite an inconsistent association with adverse neonatal outcomes.
Objective: This study aimed to evaluate the rising rate of caesarean sections performed due to non-reactive CTG and to determine the correlation between non-reactive CTG findings and neonatal outcomes.
Methodology: This prospective observational study was conducted in the department of Gynaecology and Obstetrics at Ad-din Women’s Medical College and Hospital from May 2023 to October 2023, which included pregnant women who underwent a caesarean section for non-reactive CTG. Neonatal outcomes were assessed using APGAR scores, NICU admission, and other clinical indicators to determine whether non-reactive CTG reliably predicts poor neonatal outcomes or contributes to potentially avoidable caesarean deliveries.
Results: Among 6,709 caesarean sections performed during the study period, 334 cases (4.98%) were due to non-reactive CTG. The mean maternal age was 25.7 ± 4.84 years, and mean gestational age was 37.4 ± 2 weeks. CTG was performed antepartum in 58.7% and intrapartum in 41.3% of patients. Loss of variability was the most common abnormality (45.5%). Meconium-stained liquor and cord around the neck were observed in 21% and 28.4% of cases, respectively. Most newborns (78.1%) had APGAR scores >7, while 20.4% required NICU admission, and neonatal mortality was 4.8%.
Conclusion: Non-reactive CTG was associated with relatively favorable neonatal outcomes in most cases, suggesting possible overuse of caesarean delivery based solely on CTG findings.

The Journal of Ad-din Women's Medical College; Vol. 14(1), Jan 2026; p 19-24