Abnormal fetal heart tracing patterns in patients with meconium staining of amniotic fluid and its association with perinatal outcomes


  • Bindu Vijay Kumar Department of Obstetrics & Gynecology, Government Medical College, Kozhikode, Kerala, India
  • Sajala Vimal Raj Department of Obstetrics & Gynecology, Government Medical College, Kozhikode, Kerala, India
  • Sumangala Devi Department of Obstetrics & Gynecology, Government Medical College, Kozhikode, Kerala, India




CTG, Meconium, FHR patterns, APGAR scores


Background: CTG is the most commonly used test for antepartum and intrapartum fetal surveillance. Objective: Evaluation of labours complicated by MSAF or abnormal fetal heart rate tracings or both and its predictability of adverse perinatal outcomes.

Methods: Prospective observational study of laboring patients with evidence of suspected fetal distress carried out at department of Obstetrics and Gynecology, Institute of Maternal and Child Health, Kozhikode, Kerala during the time period July 2013 - December 2013. Analysis of clinical data of 600 labouring women with evidence of presumed fetal jeopardy (either in the form of abnormal FHR tracings or MSAF or both) were done. Pregnancy variables and perinatal outcomes were compared and correlated with FHR tracings. Statistical analysis was carried out by chi-square and ANOVA tests. Level of significance was set at P value <0.05.

Results: The presence of FHR tracing abnormalities was associated with an increased risk of perinatal mortality and neonatal morbidity. There was significantly higher Caesarean Delivery (CD), low APGAR scores, higher requirement of neonatal resuscitation and admission to NICU and higher perinatal deaths among abnormal FHR tracing group.

Conclusions: 1) The presence of abnormal FHR tracing pattern in MSAF patients is associated with an increased risk of adverse perinatal outcomes. 2) Adverse fetal outcomes were also noted in patients with clear liquor but abnormal FHR tracings. 3) Similar adverse outcomes were more common in the tracing showing decelerations.


Cleary GM, Wiswell TE. Meconium stained amniotic fluid and the meconium aspiration syndrome: an update. Paediatr Clin North Am. 1998;45:511-29.

Wiswell TE, Tuggle JM, Turner BS. Meconium aspiration syndrome. Have we made a difference? Pediatrics. 1990;85:715-21.

Scott H, Walker M, Gruslin A. Significance of MSAF in the preterm population. J Perinatol. 2001;21:174-7.

Mac Donald D, Grant A, Sheridan-Pereira M, Boylan P, Chalmers I. The Dublin randomized control trial of intrapartum fetal heart rate monitoring. Am J Obstet Gynaecol. 1985;152:524-39.

Umstad MP. The Predictive value of abnormal fetal heart rate patterns in early labour. Aust NZ J Obstet Gynaecol. 1993;33:145-9.

Steer PJ, Eigbe F, Lissauer TJ, Beard RW. Interrelationship among abnormal cardiotocograms in labour, meconium staining of amniotic fluid, arterial cord blood pH and APGAR scores. Obstet Gynecol. 1989;74:715-21.

Xu H, Mas-Calve M, Wei SQ, Luo ZC, Fraser WD. Abnormal Fetal heart rate tracing in patients with thick Meconium staining of amniotic fluid, association with perinatal outcomes. Am J Obstet Gynecol. 2009;200:283.e1-7.

Dellinger EH, Boehm FH, Crane MM. Electronic fetal heart rate monitoring: early neonatal outcomes associated with normal rate, fetal stress and fetal distress. Am J Obstet Gynecol. 2000;182:214-20.

Kublin J. Antepartum fetal heart rate monitoring and ultrasound in obstetrics. In: Beard RW, Cambell S, eds. RCOG Scientific Meeting. Chicago: Kamyce Company; 2004: 342-344.

Schifrin BS. Routine fetal heart rate monitoring in the antepartum period. Obstet Gynecol. 1979;54:21-5.

Keagen KA, Paul RH. Antepartum fetal heart rate monitoring. NST a primary approach. Am J Obstet Gynecol. 1980;136:75-80.

Chauhan SP, Magnan EF, Scott SR, Scardo JA, Hendrix NW, Martin JN Jr. Caesarean delivery for fetal distress: rate and risk factors. Obstet Gynecol Surv. 2003;58:337-50.

Krebs HB, Petres RE, Dunn LJ, Jordaan HV, Segreti A. Intrapartum fetal heart rate monitoring III. Association of meconium with abnormal fetal heart rate patterns. Am J Obstet Gynecol. 1980;137:936-43.

Vintzileous AM, Nochimson DJ, Cruzman ER. Intrapartum electronic fetal heart rate monitoring vs. intermittent auscultation: a meta-analysis. Obstet Gynecol. 1995;25:149-55.






Original Research Articles