Intraoperative findings in primary caesarean section for non-reassuring fetal status and its correlation with cardiotocography

Nisha Bhatia, Krishna Kumari M.


Background: Cardiotocography plays an important role in diagnosing nonreassuring fetal status during labour, which is a leading cause for caesarean section among primigravida. These abnormal cardiotocographic traces may or may not translate into intraoperative findings of meconium stained liquor or low APGAR at birth. Hence a study is warranted to understand their correlation, thereby demonstrating the utility of cardiotocography in diagnosing nonreassuring fetal status. The objective of the study was to assess the correlation of intraoperative findings and neonatal outcome in primigravida undergoing emergency caesarean section for nonreassuring fetal status with cardiotocography.

Methods: A retrospective analysis of 104 case records of primigravida undergoing emergency caesarean section for fetal distress at Department of Obstetrics and Gynecology, Apollo Institute of Medical Sciences and Research, Hyderabad, was done. Their CTG traces were correlated with their intraoperative findings such as meconium stained liquor; nuchal cord and APGAR score at birth.

Results: Out of these 104 primigravida who underwent emergency caesarean section for nonreassuring fetal status, 63.4% had CTG with decelerations-Non reactive, 28% had a CTG trace with persistent decreased variability while 7.6% had a reactive CTG with meconium stained liquor. Among patients with CTG trace showing decelerations 54.5% had meconium stained liquor, 28.7% had cord around the neck and 43.9% had low APGAR scores at birth. Among the group of patients with decreased variability 63.4% had meconium stained liquor, 30% had cord around the neck and 30% had low APGAR scores at birth. There were 8 patients who had reactive CTG with meconium stained liquor, among them only 3 had low APGAR scores.

Conclusions: Cardiotocography positively correlates with meconium stained liquor and APGAR scores at birth, but not with the presence of nuchal cord. Hence, judicious interpretation of CTG and introduction of another noninvasive, cost effective and acceptable test to detect non reassuring fetal status is warranted to prevent unnecessary caesarean sections.


APGAR, Cardiotocography, Caesarean, Meconium stained liquor, Nuchal cord, Nonreassuring fetal status, Primigravida

Full Text:



Gravett C, Eckert LO, Gravett MG, Dudley DJ, Stringer EM, Mujobu TBM, et al. Non-reassuring fetal status: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine. 2016;34(49):6084-92.

Blackwell SC, Grobman WA, Antoniewicz L, Hutchinson M, Gyamfi Bannerman C. Interobserver and intraobserver reliability of the NICHD 3-Tier Fetal Heart Rate Interpretation System. Am J Obstet Gynecol. 2011;205:1–5.

Ancăr V, Ionescu C. Obstetrică. Editura Medicală Naţională: Bucureşti; 2000: 39-44.

Maymon E, Chaim W, Furman B, Ghezzi F, Shoham Vardi I, Mazor M. Meconium stained amniotic fluid in very low risk pregnancies at term gestation. Eur J Obstet Gynecol Reprod Biol. 1998;80:169-73.

Kohli UA, Singh S, Dey M, Bal HK, Seth A. Antenatal risk factors in emergency caesarean sections done for fetal distress. Int J Reprod Contracept Obstet Gynecol. 2017;6:2421-6.

Chauhan SP, Magann EF, Scott JR,Scardo JA, Hendrix NW, Martin JN jr. Cesarean delivery for fetal distress: rate and risk factors. Obstet Gynecol Survey. 2003;58(5):337-50.

Roy KK, Baruah J, Kumar S, Deorari AK, Sharma JB, Karmakar D. Cesarean section for suspected fetal distress, continuous fetal heart monitoring and decision to delivery time. Ind J Pediatrics. 2015;75(12):1249-52.

Low JA, Victory R, Derrick EJ. Predictive value of electronic fetal monitoring for intrapartum fetal asphyxia with metabolic acidosis. Obstet Gynecol. 1999;93:285–91.

Mundhra R, Agarwal M. Fetal Outcome in Meconium Stained Deliveries. JCDR. 2013;7(12):2874-6.

Kumar BV, Raj SV, Devi S. Abnormal fetal heart tracing patterns in patients with meconium staining of amniotic fluid and its association with perinatal outcomes. Int J Reprod Contracept Obstet Gynecol 2015;4:629-33.

Sunitha C, Rao PS, Prajwal S, Bhat RK. Correlation of intrapartum electronic fetal monitoring with neonatal outcome. Int J Reprod Contracept Obstet Gynecol. 2017;6:2174-9.

Desai D, Maitra N, Patel P. Fetal heart rate patterns in patients with thick meconium staining of amniotic fluid and its association with perinatal outcome. International J Reproduction, Contraception, Obstetrics Gynecol. 2017;6(3):1030-5.

Larson JD, Rayburn WF, Crosby S, Thurnau GR. Multiple nuchal cord entanglements and intrapartum complications. Am J Obstet Gynecol. 1995;173:1228-31.

Ozden S, Demirci F. Significance for fetal outcome of poor prognostic features in fetal heart rate traces with variable decelerations. Arch Gynecol Obstet. 1999;262(3-4):141-9.

Assunção SEM, Bonini CJAD, Maria IS, Rodrigo R, Marcelo Z. Low Apgar scores at 5 minutes in a low risk population: maternal and obstetrical factors and postnatal outcome. Rev Assoc Med Bras. 2012;58(5):587-93.