Correlation of admission cardiotocography and amniotic fluid index in improving the perinatal outcome in uncomplicated pregnancies (original) (raw)
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Background and objectives: in past, mother and child are considered as one unit. Today fetus is no longer considered a maternal appendage, but it has got a separate status for its care as fetus faces faces greater risk of mortality and morbidity. Cardiotocography was incorporated in clinical obstetrics to reduce intrapartum mortality and morbidity.intrapartum monitoring has infact improved fetal outcome and normal survival is now possible in cases considered hopeless years ago. cardiotocography is a simple, safe, non invasive and economical investigation which can be done on every patient in labour. This test should be a part of intrapartum fetal surveillance. The abnormal pattern are recognized and necessary and timely intervention is done, thereby saving mother and fetus. Hence this topic has been taken to evaluate the perinatal outcome following the early recognition of abnormal CTG and early intervention made. Objective: the main goal of the study was to correlate abnormal cardiotocography and perinatal outcome and. To formulate the plan of acton depending on the result and to study the outcome of pregnancy.to reduce perinatal mortality and morbidity by including cardiotocography as an routine investigation during vaginal delivery. Method: the present study is a simple random sampling which includes minimum of 100 term pregnant women in labour with in a period of 15 months with abnormal cardiotography admitted in the Niloufer hospital, Hyderabad all women in active labour with singleton, term pregnancy, with cephalic presentation CTG tracings were taken, preferably 30 minutes before delivery or even earlier with FHR irregularities. CTG tracing were defined as non-reassuring and abnormal patterns as per NICE guidelines 2016. Reassuring patterns were excluded from the study. After delivery apgar score at 1 and 5 minutes were taken. NICU admission were analyzed and followed up till discharge. twin pregnancies, eclampsia, antepartum haemorrhage, preterm deliveris were excluded from the study. Results: among the 100 patients 48(48%) showed nonreassuring FHR patterns, 52(52%) showed abnormal FHR patterns. Variable decelerations were commonest abnormal CTG patterns and seen in 32% of cases, next common was tachycardia in 32%, bradycardia in 30%, late deceleration in 22%, 27% of cases delivered vaginally, among them 19% were in the non-reassuring FHR group. Operative interventions were done in 73(73%) of them 55(55%) with caesarean deliveries and 18(18%) with instrumental deliveries. 1 min apgar score <7 (depressed) was 29.16% and 40.38% in non-reassuring and abnormal groups respectively with sensitivity of 90%, specificity of 19%, positive predictive value 69% and negative predictive value 97.3% 5 min apgar score <7 were 7% and 12% in non-reassuring and abnormal groups respectively with sensitivity of 77%, specificity 60%, positive predictive value 12.7% and negative predictive value 97%.admission to NICU were 13% and !*% in non-reassuring and abnormal FHR groups and 4 in instrumental vaginal delivery and 7 in vaginal delivery. Conclusion: Abnormal CTG predicts the fetal outcome, ie poor Apgar score at 1 min and 5 minutes, increased rate of caesarean section and neonatal resuscitation. CTG is an important test to assess the fetal condition in intrapartum period. The sensitivity of CTG was 96%, specificity was 63%, positive predictive value was 22% and negative predictive value was 99% in the prediction of abnormal outcomes. In spite of increased operative delivery there was decreased rate of NICU admissions and neonatal deaths providing that early intervention esuscitation and will improve neonatal out come. Here by I conclude that continuous EFM should be offered and recommended for highrisk pregnancies where there is an increased risk of perinatal death.
Association of Apgar Score With Meconium Staining of Amniotic Fluid in Labor
Cureus, 2021
This study aimed to determine the association of Apgar score with meconium staining of amniotic fluid in labor. Methodology A retrospective observational study was carried out through the non-probability convenient sampling technique at the Department of Obstetrics and Gynecology for a duration of six months. Only those women were selected who had more than 24 weeks of gestation period. The women were excluded on the basis of risk factors for fetal distress and breech in late labor. Results A total of 216 pregnant women were selected from the labor room in this study. The mean age of the women was 26.57±4.28 years. The gestational age of the women was 36.09±4.11 weeks. Moreover, the mean parity of pregnant women was 1.68±2.53. It has been observed that the women who had meconium staining, the neonates of 144(77.4%) women showed the Apgar score of less than six at one minute. However, for the women without meconium staining, the neonates of only 15(50%) women showed the Apgar score of less than six at the one-minute interval with a significant association (p=0.02). With respect to age groups, a significant association of meconium staining with Apgar score was noted in the 21-30 years age group, whereas, no significant association was seen in other age groups. Similarly, a significant association of meconium staining and Apgar score was noted in primiparous women, whereas, no significant association was noted in multiparous women. No significant association of Apgar score and meconium staining was seen with respect to the mode of delivery. Conclusion The study has found a relation between the Apgar score and meconium staining of amniotic fluid and reported that the Apgar score of less than six at one minute was significantly associated with meconium staining of amniotic fluid.
Normal and abnormal liquor volume and its correlation with perinatal outcome
The New Indian Journal of OBGYN, 2019
Aim: To assess and compare the perinatal outcome among mothers with normal and abnormal amniotic fluid volume. Methodology: A prospective comparative study was conducted for a period of one year from January 2016 to December 2016. Group I consist of 50 patients with normal amniotic fluid and group II consists of 50 patients with either oligohydramnios or polyhydramnios. Amniotic fluid index (AFI) was calculated using Phalen's four quadrant technique using ultrasound. The perinatal outcome was judged by assessing the fetal distress predicted by abnormal fetal heart rate (FHR) or meconium stained liquor, one minute and 5 minute Apgar score, frequency of admission to neonatal intensive care unit (NICU), baby weight of less than 10th percentile for gestation age and perinatal mortality. Results: Induction of labour, caesarean section and meconium stained liquor was found to be most common among the patients in group II (abnormal AFI) in comparison with normal AFI subjects and similarly the perinatal outcome measures like low birth weight, increased frequency of admission to NICU due to respiratory distress and a low APGAR score was more commonly found in abnormal AFI group and the difference was found to be statistically significant. Conclusion: AFI measurement in antepartum or intrapartum period can help to identify women who need increased antepartum surveillance for pregnancy complications and such women should be managed in a special unit to combat the complications effectively.
Low Amniotic Fluid Index as a Predictor of Adverse Perinatal Outcome â An Indian Perspective
Clinics in Mother and Child Health, 2015
Background: Oligohydramnios has increased incidence of meconium stained liquor, abnormal FHR tracing, low Apgar score, low birth weight, admission to NICU, birth asphyxia and cesarean section for fetal distress. Objective: To compare the perinatal outcome in women with singleton term pregnancies having amniotic fluid index (AFI) < 5cm to those having AFI between 6 to 20 cm. Material and methods: It is a prospective comparative study which included a total of 100 women with singleton term pregnancy with cephalic presentation, divided into two groups of 50 each. Women in Group 1 had amniotic fluid index <5 cm and in Group 2, had AFI from 6-20 cm. Primary outcome measures were fetal distress, meconium stained amniotic fluid, Apgar score less than seven at five minutes and low birth weight. Secondary outcome measures were caesarean section, neonatal complications and admission in NICU. Results: An AFI <5 cm was associated with significant high rate of induction of labor (p<0.001), caesarean section (p=0.04) and fetal distress (p<0.05). Meconium-stained liquor (p=0.76), Apgar score less than seven at 5 minutes (p=0.307), low birth weight (p=0.130) or NICU admission (p=1) were comparable in the two groups. Conclusion: Low AFI (<5cm) at term is associated with significantly high rate of intrapartum fetal distress and caesarean section, though the neonatal outcome is not affected by the AFI levels.
The Professional Medical Journal
A comparative study was conducted in CMH, Malir, CMH, Kharian andWT (Pvt) Ltd. Gynaecology and Obstetrics, Multan from April 2001 to March 2004. The Apgar score of neonate wascompared for thiopentone or propofol in C-section patients. Two groups of patients were made. Group-A was inducedwith thiopentone and group-B was induced with propofol. Each group had 100 patients. In group-A 13 neonatesrequired manipulation and 2 neonates in group-B also required manipulation like mask ventilation or endotrachealintubation and one of drugs like atropine to improve apgar score. 13% neonates in group-A and 1% neonates in group-B required manipulation. This clearly shows the superiority of propofol over thiopentone as an induction agent in Csection.The P value of group-A was 0.13 and for group B was 0.02 and had had a statistically significant difference.
The Professional Medical Journal
Objectives: To compare neonatal outcome in laboring patients having fetal distress on cardiotocography in clear liquor vs meconium stained liquor. Study Design: Cohort study. Setting: Department of Obstetrics and Gynaecology, Military Hospital, Rawalpindi. Period: Six months from 31-01-2016 to 30-07-2016. Patients and Methods: One hundred and eighty two patients (91 in each group) were included in this study. All relevant information was recorded on a preset data collection proforma that included gestational age, cardiotocography (CTG) details, color of liquor and Apgar score at 1 and 5 minutes after birth. In all admitted patients CTG was carried out. Results: The age ranged from 20-40 years of the patients with Mean±SD age of 29.8±6.1 and 30.4±5.7 year in group-A and B, respectively. Regarding Apgar score at 1 minute, 2 (2.1%) babies from group-A and 9 babies (9.8%) from group-B had Apgar score…
Admission cardiotocography:Its role in predicting foetal outcome in high risk
Australasian Medical Journal, 2012
Routine and continuous electronic monitoring of foetal heart rate (FHR) in labour has become an established obstetric practice in high--risk pregnancies in industrialised countries. However, the same may not be possible in non-industrialised countries where antenatal care is inadequate with a large number of high--risk pregnancies being delivered in crowded settings and inadequate health care provider to patient ratios.
Role of Elaborate Cardiotocography (CTG) in Pregnancy Management
Bangabandhu Sheikh Mujib Medical University Journal, 2009
Background: Elaborate Cardiotocography (CTG) is the most commonly used test for antepartum and intrapartum fetal surveillance because it gives information via the cerebro-cardiac response of fetal cerebral activity, which is modified by the hypoxia. Objective: This study was designed to compare the perinatal outcomes among the normal and abnormal CTG groups. Method: It was a prospective observational study carried out in the Department of obstetrics, BSMMU during the period July 2006 to July 2008. Hundred consecutive normal and hundred consecutive abnormal CTC tracings were collected from patients who were advised to perform CTG after admission. Both labour and non-labour patients were included. Interpretation of CTG was done based on FlGO recommendation (1987). Pregnancy and neonatal data were obtained and the findings were correlated with the FHR tracing. Statistical analysis was carried out by student's unpaired t-test, X 2 and Z-test. Level of significance was set at P value < 0.05. Results: Out of 100 abnormal CTG, 30% had tachycardia, 42% had deceleration, 38% was non reactive, 4% had absence beat-to-beat variability and 4% had fetal bradycardia. There was significantly higher caesarean delivery, lower apgar score, higher requirement of neonatal resuscitation and admission at neonatal unit and higher perinatal death among the abnormal CTG group. The abnormal fetal outcome was found highest in heart rate deceleration group. Conclusion: CTG can be continued as a good screening test of fetal surveillance but it is not the sole criteria to influence the management of high-risk pregnancies. Abnormal CTG should be supplemented with other test before intervention.