Introduction: Monitoring labor and delivery is central to preventing maternal and neonatal morbidity and mortality. The available methods are cardiotocography (CTG) and intermittent auscultation, but their predictive value and clinical impact remain debated in resource-limited countries. Objective: To compare maternal and fetal outcomes based on the mode of intrapartum monitoring and propose a simple prediction tool for acute fetal asphyxia (AFA) in Cameroon. Methods: A longitudinal observational study with an analytical component was conducted in four hospitals in Douala. A total of 498 deliveries were included: 195 monitored by CTG and 303 by intermittent auscultation. The variables studied included maternal, obstetric, and neonatal characteristics. The main outcomes were the mode of delivery, neonatal asphyxia (Apgar score < 7 at 5 minutes), transfer to intensive care, and neonatal mortality. Statistical analyses used the Chi-square and Student’s t-test, with a significance level set at p < 0.05. Results: The cesarean section rate was higher with CTG than with auscultation (21.5% vs. 6.3%; p = 0.07), without a significant benefit on neonatal outcomes. The overall incidence of neonatal asphyxia was 8.2%. The appearance of clear amniotic fluid was protective against cesarean sections (p = 0.001) and neonatal asphyxia (p = 0.020). Based on intrapartum determinants (parity, maternal age, gestational age, amniotic fluid appearance, CTG tracing), we developed the DASH Score (Douala Asphyxia Scoring in Hospitals), which allows for rapid stratification of the risk of neonatal asphyxia. Conclusion: CTG increases the rate of cesarean sections without significantly improving neonatal prognosis. Simple parameters such as the appearance of amniotic fluid are reliable indicators of asphyxia. The DASH Score offers a practical prediction tool in resource-limited settings and warrants prospective validation.
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