Predictive Value of Admission Cardiotocogram Test in Perinatal Outcome

Abstract

BACKGROUND The present study was undertaken to test the reliability of admission test to identify compromised foetuses and to correlate the test results with different parameters of adverse foetal outcome and mode of delivery. MATERIALS AND METHODS An admission Foetal Heart Rate (FHR) tracings was obtained by cardiotocogram on 100 antenatal mothers, both high and low risk in early labour for 20 minutes and then categorised based on RCOG criteria for interpretation of admission test. Perinatal outcome and mode of delivery were analysed with the help of Kruskal-Wallis chi square test. RESULTS 1. Preeclampsia was the most common high risk factor in our study. 2. Mean gestational age at delivery in high risk group was 37 weeks compared to 39 weeks in low risk group. 3. The percentage of LSCS is more in non-reactive tracings, but this value is not statistically significant as p value is 0.0524 in high risk group and 0.0636 in low risk group. 4. In high risk category in non-reactive group, 6 out of 9 i.e. 66.7% had low Apgar score making the p value 0.0001, which is statistically significant. 5. The duration of hospital stay was also more in babies with non-reactive tracings, a mean of 7 days as compared to 5 days in reactive group in high risk patients. This value is statistically significant as the p value is 0.04. 6. The specificity of admission test in predicting perinatal mortality in high risk pregnancies is quite high; it is 95% and the negative predictive value is 93%. The sensitivity of the test is 70% and positive predictive value is found to be 78%. CONCLUSION By analysing our study carefully and comparing it with similar studies in literature we can conclude any non-reactive tracings should be extended for 40 minutes along with foetal stimulation to reduce the false positive rates. Admission test increases the rate of LSCS in both high and low risk groups. Non-reactive traces in both high and low risk groups are associated with more foetal distress, low Apgar, prolonged NICU care and increased perinatal mortality.