Pregnancy outcomes of normal versus abnormal cardiotocography in a tertiary centre in Nepal

Abstract

Background: Pregnancy and childbirth is normal physiological process with great pathological potential. The obstetricians are more concerned with the early recognition of fetal distress during labour and such an adverse outcome should be detected at the earliest point of time by an effective surveillance method. Cardiotocography as a part of biophysical profile has become an established diagnostic tool for fetal surveillance. To compare early perinatal outcome of normal and abnormal cardiotocography in terms of APGAR scores, need for neonatal resuscitation, NICU admission, perinatal death and mode of delivery.Methods: It was a cross-sectional study. 200 nulliparous/multiparous women with singleton pregnancy in cephalic presentation at gestational age 37-42 weeks in latent stage of labor were enrolled in the study and subjected to admission test in left lateral position using fetal monitor. Baseline FHR and contraction pattern were determined for 20 minutes and classification of patients was done into normal, and suspicious or abnormal according to the FIGO guidelines 2015.Results: Low APGAR scores, rate of LSCS, need for neonatal resuscitation, neonatal admission were more in the abnormal cardiotocography group. Cardiotocography in the current study has high sensitivity and high negative predictive value for detecting fetal distress.Conclusions: From the analysis of this study, it would be safe to conclude that an ominous cardiotocography should be managed appropriately without delay and obstetrician should be vigilant in suspicious as well as in normal admission test group for timely intervention for bettering the neonatal outcome.

The Role of Cardiotocography in Monitoring Fetal Condition During Labour in High Risk Pregnancy and Its Correlation with Perinatal Outcome

“…This study showed that the patients with bloody liquor and non-reactive CTG were more prone to cesarean section. These findings are in accordance with studies of (Faruqi et al, 2019;Khatun et al, 2009) who reported that most of the patients in the non-reactive CTG tracing group underwent a cesarean section (90.0%) compared to 90.0% by normal vaginal delivery in reactive CTG tracing group, and 3% by cesarean section) 11,12 .…”

“…Regarding the perinatal outcome, babies of women with non-reactive CTG were more likely to have low Apgar score (0-4) in 1 minute and Apgar score (5)(6)(7) in five minutes, and babies were more likely to be admitted to NICU (Neonatal Intensive Care Unit). Some other studies (Faruqi et al, 2019;Sood, 2002;Behuria and Nayak, 2016) have found that the patients with non-reactive CTG tracing have less Apgar score compared to the patients with reactive CTG tracing 11,13,14 . In a study conducted by Faruqi et al, (2019) reported that Apgar score of the babies in the reactive CTG tracing in the first min was >7 among 98% babies, 5-6 in 2% babies, and <5 in 0% compared to 92%, 5%, and 3% in nonreactive CTG tracing group 11 .…”

“…Some other studies (Faruqi et al, 2019;Sood, 2002;Behuria and Nayak, 2016) have found that the patients with non-reactive CTG tracing have less Apgar score compared to the patients with reactive CTG tracing 11,13,14 . In a study conducted by Faruqi et al, (2019) reported that Apgar score of the babies in the reactive CTG tracing in the first min was >7 among 98% babies, 5-6 in 2% babies, and <5 in 0% compared to 92%, 5%, and 3% in nonreactive CTG tracing group 11 . In agreement with the current study, a study reported that babies of patients with nonreactive CTG were more likely to be admitted to NICU (75.7%v/s 22.8%).…”

Predictive value of admission and intrapartum cardiotocography in normal and high risk antenatal women

“…Faruqi et al, reported that the mode of delivery in the abnormal NST group, 90% of the women had caesarean section, 9% had normal vaginal delivery and only 1% had instrumental vaginal delivery whereas 90% had normal vaginal delivery, 7% had caesarean section and only 3% had instrumental delivery in normal NST group. 10 In this study, Category I (reactive) was significantly more among low risk group whereas Category II (equivocal) and Category III (non-reassuring) was significantly more among high risk group.…”

“…Faruqi et al, reported that the mode of delivery in the abnormal NST group, 90% of the women had caesarean section, 9% had normal vaginal delivery and only 1% had instrumental vaginal delivery whereas 90% had normal vaginal delivery, 7% had caesarean section and only 3% had instrumental delivery in normal NST group. 10 Rahman et al found that incidence of neonates getting admitted in ICU was highest in patients with ominous admission test (62%), compared to those with reactive (3.5%) and equivocal admission test (27.8%). 15 Similar rates of NICU admission are reported by Perveen et al that is, 66.67% NICU admission in ominous group and 6.6% in reactive group.…”