Abnormal cardiotocographic findings and perinatal outcome: a prospective study
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20194841Keywords:
Abnormal heart rate features, Cardiotocography, Perinatal outcomeAbstract
Background: CTG as an intrapartum fetal surveillance can be judged appropriately taking the abnormal features of CTG individually into account for decision making of early delivery to reduce the fetal and neonatal morbidity. Objectives of this study were to identify the fetuses at risk of developing hypoxia as evidenced by abnormal FHR pattern seen by CTG and to correlate the abnormal features with perinatal outcome and find out the most specific feature among all abnormal features of CTG in detecting the adverse perinatal outcome.
Methods: This was an observational study where total of 249 uncomplicated pregnant patients in active labor were selected randomly and CTG were done for them. Progress of labor was recorded in partogram. Only pathological CTGs were considered for early decision of delivery by LSCS. After delivery Apgar score 1 min, 5 min, baby weight, colour of liquor, NICU admission and no of days of admission in NICU were recorded.
Results: For liquor colour, variability and absence of acceleration were good screening heart rate features and baseline was considered the most specific feature. For all babies with poor Apgar score at 1 min, abnormal baseline was the most specific feature. For NICU admission, the abnormal baseline the most specific feature. Acceleration was found to be the most sensitive heart rate feature among all other heart rate features. Liquor colour had better sensitivity for detecting poor Apgar score at 1min and 5 min. There was increase rate of cesarean section and operative vaginal delivery.
Conclusions: Abnormal intrapartum CTG features of an uncomplicated laboring mother >37 weeks can detect fetuses at distress with different specificities and sensitivities when considered individually and can reduce the perinatal morbidity.
References
Parer JT, Livingston EG. What is fetal distress? Am J Obstet Gynecol. 1990;162(6):1421-7.
Dastur AE. Intrapartum fetal distress. J Obstet Gynecol India. 2005;55(2):115-7.
Gorzelac L, Czajkowska EP, Oleszczuk J. Intrapartum cardiotocography and fetal pulse oximetry in assessing fetal hypoxia. Int J Gynecol Obstet. 2002;76:9-14.
Vardhan S, Bhattacharya TK, Kathpalia SK, Kochar SPS. Intrapartum electronic fetal monitoring: Does it lead or mislead? MJAFI. 2006;62:51-2.
Cunningham G, Norman F, Kenneth J. Intrapartum Assessment: Williams Obstetrics 22nd edition; Section IV, chapter 18; 2005:447-457.
Low JA, Simpson LL, Tonni G, Chamberlain S. Limitations in the clinical prediction of intrapartum fetal hypoxia. Am J Obstet Gynecol. 1995;172:801-4.
Goodlin RL, Haesslein HC. When it is fetal distress? Am J Obstet Gynecol. 1977;128:440-5.
Grant A, O’ Brien N, Joy MT. Cerebral palsy among children born during the Dublin randomized trial of intrapartum monitoring. Lancet. 1989;2:1233-6.
Gourounti K, Sandall J. Admission Cardiotocography versus intermittent auscultation of fetal heart rate: effects on neonatal Apgar score, on the rate of cesarean section and on the rate of instrumental delivery. Int J Nurs Stud. 2007;44(6):1029-40.
Impey L, Reynolds M, MacQuillan K, Gates S, Murphy J, Sheil O. Admission cardiotocography: a randomised controlled trial. The Lancet. 2003;361(9356):465-70.
Vintzileos AM, Antsaklis AR, Varvarigos IO, Papas CO, Sofatzis IO, Montgomery JT. A randomized trial of intrapartum fetal heart rate monitoring versus intermittent auscultation. Obstet Gynecol. 1993;81:899-907.
Zalar RW, Quilligan EJ. The influence of scalp sampling on the cesarean section rate for fetal distress. Am J Obstet Gynecol. 1979;135:239-46.
Steer PJ, Eigbe F, Lissaeur TJ, Beard RW. Interrelationship among abnormal cardiotocograms in labour, meconium staining of amniotic fluid, arterial cord blood pH and Apgar scores. Obstet Gyneco. 1989;74:715-21.
Palomaki O, Leukkaala T, Luoto R, Tuimala R. Intrapartum Cardiotocography the dilemma of interpretational variation. J Perinat Med. 2006;34(4):298-302.
Mahomed K, Nyomi R, Mulambo T, Kasula J, ]acobus E. Randomised controlled trial of intrapartum fetal heart rate monitoring. BMJ. 1994;308:497-500.
