Intrapartum category II cardiotocography and its association with mode of delivery and perinatal outcomes in term pregnancy: a prospective observational study
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20262338Keywords:
Fetal heart rate monitoring, Caesarean section, Fetal monitoring, Labor, Obstetric, Neonatal morbidity, PregnancyAbstract
Background: Intrapartum cardiotocography (CTG) is widely used for foetal surveillance. However, Category II CTG has variable patterns and uncertain significance, often leading to operative delivery in pregnant women. This study aimed to assess the association between intrapartum Category II CTG, mode of delivery, and perinatal outcomes in term pregnancies.
Methods: This prospective observational study was conducted at the Department of Obstetrics and Gynaecology, Sri Ramakrishna Hospital, Coimbatore, between December 2019 and August 2020. A total of 103 consecutive term pregnant women with intrapartum Category II CTG were included. The mode of delivery and perinatal outcomes were analysed in relation to parity, modified Bishop score, CTG duration, and CTG pattern type.
Results: Among the study population, 55.3% underwent emergency caesarean section, while 44.7% delivered vaginally, including 31.1% by operative vaginal delivery and 13.6% by normal vaginal delivery. All women with unfavourable modified Bishop scores underwent emergency caesarean section (100%). With favourable Bishop scores, operative vaginal delivery was common in both primigravida (42.6%) and multigravida (40.9%) groups. The duration of category II CTG differed according to parity (p=0.041) but was not associated with neonatal outcomes. NICU admission occurred in 37.9% of neonates, most frequently with reduced variability (66.7%) and foetal tachycardia (55.6%) (p=0.027). Most NICU stays were less than 24 h (60.5%).
Conclusions: Intrapartum Category II CTG is associated with higher operative delivery rates; however, perinatal outcomes are generally favourable and depend more on CTG pattern type than on duration. Careful intrapartum reassessment may help reduce unnecessary caesarean sections.
References
Hooper DE, Grayson J, Elsamadicy E. Review of category I, II, and III fetal heart rate classifications. Fam Med Obstet. 2014;1:1-6.
Murray ML. Uterine activity impacts fetal and neonatal outcomes. Int J Childbirth. 2020;10:2-9.
Ayres-de-Campos D, Arulkumaran S. FIGO Intrapartum Fetal Monitoring Expert Consensus Panel. FIGO consensus guidelines on intrapartum fetal monitoring: introduction. Int J Gynaecol Obstet. 2015;131:3-4.
Malhotra A, Allison BJ, Castillo-Melendez M, Jenkin G, Polglase GR, Miller SL. Neonatal morbidities of fetal growth restriction: pathophysiology and impact. Front Endocrinol (Lausanne). 2019;10:55.
Santo S, Ayres-de-Campos D, Costa-Santos C, Schnettler W, Ugwumadu A, Da Graça LM, et al. Agreement and accuracy using the FIGO, ACOG and NICE cardiotocography interpretation guidelines. Acta Obstet Gynecol Scand. 2017;96:166-75.
Knupp RJ, Andrews WW, Tita ATN. The future of electronic fetal monitoring. Best Pract Res Clin Obstet Gynaecol. 2020;67:44-52.
Weissbach T, Heusler I, Ovadia M, David L, Daykan Y, Schreiber F, et al. The temporal effect of Category II fetal monitoring on neonatal outcomes. Eur J Obstet Gynecol Reprod Biol. 2018;229:8-14.
Small KA, Sidebothem M, Fenwick J, Gamble J. Intrapartum cardiotocograph monitoring and perinatal outcomes for women at risk: literature review. Women's Birth. 2020;33:411-8.
Alfirevic Z, Devane D, Gyte GM, Cuthbert A. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev. 2017;2:CD006066.
Simpson KR. Managing an indeterminate (category II) fetal heart rate tracing during labor. MCN Am J Matern Child Nurs. 2014;39:212.
Pevzner L, Alfirevic Z, Powers B, Wing D. Cardiotocographic abnormalities associated with misoprostol and dinoprostone cervical ripening and labor induction. Am J Obstet Gynecol. 2009;201(l):S124.
Gupta M, Gupta P. Role of cardiotocography in high-risk pregnancy and its correlation with increased cesarean section rate. Int J Reprod Contracept Obstet Gynecol. 2016;6:168-72.
Michaeli J, Srebnik N, Zilberstein Z, Rotem R, Bin-Nun A, Grisaru-Granovsky S. Intrapartum fetal monitoring and perinatal risk factors of neonatal hypoxic-ischemic encephalopathy. Arch Gynecol Obstet. 2021;303:409-17.
Holzmann M, Wretler S, Cnattingius S, Nordström L. Cardiotocography patterns and risk of intrapartum fetal acidemia. J Perinat Med. 2015;43:473-9.
Xu H, Mas-Calvet M, Wei SQ, Luo ZC, Fraser WD. Abnormal fetal heart rate tracing patterns in patients with thick meconium staining of the amniotic fluid: association with perinatal outcomes. Am J Obstet Gynecol. 2009;200:283-e7.
Frey HA, Tuuli MG, Shanks AL, Macones GA, Cahill AG. Interpreting category II fetal heart rate tracings: does meconium matter? Am J Obstet Gynecol. 2014;211:644.e1-8.
Downloads
Published
How to Cite
Issue
Section
