Sub partu monitoring of the fetus by cardiotocography and fetal blood analysis (original) (raw)
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Predictive accuracy of intrapartum cardiotocography in terms of fetal acid base status at birth
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2009
To find out the predictive value of intrapartum Cardiotocograph (CTG) in terms of fetal acid base status at birth in women undergoing emergency caesarean section for a suboptimal CTG trace. Observational study. At the MCH Centre, Pakistan Institute of Medical Sciences, Islamabad, from June 2004 to July 2005. All women undergoing emergency caesarean section for a suboptimal intrapartum CTG were recruited in the study. Immediately after the delivery of the baby a segment of umbilical cord was doubly clamped at a distance of 10 cm, and 2 ml of arterial cord blood was taken in a heparinized syringe for arterial blood gas indices analysis. All CTG tracings were reviewed using FIGO guidelines and compared for fetal arterial blood gas indices. Of the 57 patients who underwent cesarean section due to suboptimal CTG, 51 (89%) had suspicious trace while 6 (11%) had pathological trace. Positive predictive value of CTG was 18% for fetal hypoxia, 21% for fetal hypercarbia., 26% for fetal acidosi...
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.
Archives of Gynecology and Obstetrics, 2010
Objective In this study, we tried to establish cut-oV values for more than one parameters of computerized cardiotocography (c CTG) in the prediction of fetal distress during labor, using a group of pregnant women with low-risk pregnancies. Method A retrospective study was performed. Data were collected from 167 patients for measurements of fetal heart rate (FHR) variables and perinatal outcome. Computerized CTG was performed with an Oxford Sonicaid monitor with connection to a 8000 system for CTG spontaneous analysis. The following c CTG variables were considered: FHR, number of accelerations, the presence and the number of episodes of high and low variation, the number of decelerations, short-term variation (STV), peaks of contractions (per hour) and fetal movements assessed by maternal perception (per hour). Computerized CTG recordings started not earlier than the beginning of week 38 of gestation. Immediately after delivery, blood sample was collected from umbilical artery for umbilical artery blood gas analysis (UBGA). The main UBGA parameter in cord umbilical artery that was considered for analysis was pH. pH values <7.25 were considered as suspicious for acidemia and pH values ¸7.25 as normal. Results Women suspicious for fetal distress during labor presented signiWcantly lower fetal movements (P = 0.026), accelerations (P = 0.018), variability (P < 0.001), number of high episodes (P < 0.001), higher values of FHR baseline (P < 0.001) and low episodes (P < 0.001). Only the number of decelerations did not diVer signiWcantly between the two groups (P = 0.545). The cut-oV points of 5.00 for STV and 3.00 for high episodes were determined to classify women with fetal distress, which yielded high sensitivities (34 and 52%) and speciWcities (96.6 and 94.9%), with positive predictive values of 81.0 and 81.3% and negative predictive values of 77.4 and 82.2%, respectively. Conclusions In conclusion, we believe that not only STV but also other components of the cCTG, mainly the presence and the number of episodes of high variation, are related to pregnancy's outcome as measured by an umbilical artery pH.
Journal of SAFOG, 2023
Background: Early and accurate detection of fetal asphyxia is crucial to prevent perinatal mortality and morbidity. This study aims to study the relationship between the intrapartum fetal condition by cardiotocography (CTG) and paired umbilical cord pH and to correlate the CTG to the paired umbilical cord pH. Methods: A cross-sectional observational study was conducted in the Department of Obstetrics and Gynaecology in Kasturba Hospital, Delhi. Only singleton-term non-high-risk pregnancies with cephalic presentation admitted in active labor were included in the study. About 360 participants were recruited, and CTG was performed on all of them at admission, at rupture of membranes (ROM), and before delivery. Those with normal and indeterminate CTG were labeled as controls, and those with abnormal CTG were labeled as the study group. There were 300 controls and 60 subjects in the study group. Cardiotocography was performed at admission, at ROM, and before delivery. Immediately after delivery, paired cord samples were collected for blood gas analysis. Umbilical arterial (UA) pH < 7.1 and umbilical venous (UV) pH < 7.2 were taken as acidosis according to institutional guidelines. Results: There was a significant association between CTG at ROM and acidosis by UA pH (p = 0.0015), UA base deficit (p < 0.0001), and UV pH (p < 0.00001). Also, a significant association between CTG before delivery and acidemia by UA pH (p < 0.00001), UA base deficit (p < 0.00001), and UV pH (p < 0.00001) was found. Conclusion: An abnormal CTG trace predicts a greater possibility of intrapartum fetal acidosis. Therefore, screening by CTG before delivery as a routine is recommended. The practice of performing CTG in labor rooms in peripheral health centers where blood gas analysis machines are not available would enable early prediction and risk estimation in short-term neonatal outcomes, thereby decreasing associated morbidity and mortality.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: The purpose of intra-partum fetal monitoring is to identify early signs of developing hypoxia. Electronic fetal monitoring is performed using cardiotocograph, which is a paper record of the fetal heart rate (FHR) patterns plotted simultaneously in relation to uterine activity. In low resource settings umbilical cord artery blood gas analysis can provide important information about the foetuses exposed to intrapartum hypoxaemic events and can distinguish the infant at high risk for asphyxia and related sequelae. The aim of this study was to correlate intrapartum CTG findings with umbilical cord blood pH at birth in term pregnancies in labour and thus evaluate the success of CTG in predicting fetal acidosis during labour.Methods: The present study included 301 consecutive women with term singleton pregnancies in labour. Intrapartum CTG was taken and classified into normal (category I trace), indeterminate (category II trace) and abnormal (category III trace) according to N...
Introduction: Electronic fetal heart rate monitoring (EFM) involves the use of a cardiotocography (CTG) to record the fetal heart rate (FHR) so as to determine the fetal well-being in order to detect signs of intrapartum hypoxia. Objectives: The objective of this study is to find relationship between abnormal cardiotocography and cord blood pH at birth in term pregnancies. Material and methods: This Observational study was conducted at Services hospital Lahore during 2019. From all females or attendants, their contact information, demographic, gestational history was taken. Immediately after the delivery of the baby, about 10 cm of umbilical cord was doubly clamped. Two milliliters of arterial cord blood was taken in a pre-heparinized syringe and sent to laboratory within 10 minutes for assessment of fetal pH. According to operational definition pH levels < 7 was noted. All data was collected on performa by researcher herself. Results: The data was collected from 323 patients. The mean gestational age was 39.27±5.65 weeks. The mean birth weight of new born was 3189±203.48 grams. The most common perinatal risk factors accompanied with low umbilical artery pH were prolonged rupture0 of membranes, breech presentation, and meconium stained amniotic fluid. According to data, there was no significant correlation between cardiography and 5 th minute umbilical cord pH in term pregnancies. Conclusion: It is concluded that cardiotocography (CTG) had become a popular method for monitor fetal wellbeing and it is assisting the obstetrician in making decision on the mode of delivery to improve perinatal outcome. But there is no significant relationship between CTG and cord blood pH.
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.
Acta Obstetricia et Gynecologica Scandinavica, 2004
Background. To study the relationship between antepartum computerized cardiotocography (cCTG) and the evolution of intrapartum fetal acid-base balance in a low-risk population. Methods. Forty-nine healthy fetuses were prospectively followed up by antepartum cCTG (Oxford System 8002), fetal scalp blood sampling at the onset of the active phase of dilatation (3 cm) and at the beginning of the second stage of labor (10 cm) and study of acid-base status at birth in the umbilical cord. Correlation studies and linear regression analysis were performed. Results. Normal prelabor cCTG was followed by normal fetal acid-base balance in the different study periods. No relationship was found between cCTG parameters and the absolute values of fetal acid-base status. However, the more favorable the antepartum cCTG parameters were, the more favorable the fetal acid-base evolution during the active phase of dilatation was. In contrast, no significant correlations were found between antepartum cCTG and fetal acid-base changes during the second stage of labor. Conclusions. In normal fetuses, a single antepartum cCTG identified correctly fetal wellbeing during labor and at birth and was able to predict fetal acid-base evolution during the active phase of dilatation. However, fetal biochemical changes during the second stage could not be predicted by any antepartum cCTG parameter.
Cardiotocography and ST analysis for intrapartum fetal monitoring
Acta Obstetricia et Gynecologica Scandinavica, 2012
Objective. To undertake a renewed analysis of data from the previously published Swedish randomized controlled trial on intrapartum fetal monitoring with cardiotocography (CTG-only) vs. CTG plus ST analysis of fetal electrocardiogram (CTG+ST), using current standards of intention-to-treat (ITT) analysis and to compare the results with those of the modified ITT (mITT) and per protocol analyses. Methods. Renewed extraction of data from the original database including all cases randomized according to primary case allocation (n=5 049). Main outcome measure. Metabolic acidosis in umbilical artery at birth (pH <7.05, base deficit in extracellular fluid >12.0mmol/l) including samples of umbilical vein blood or neonatal blood if umbilical artery blood was missing. Results. The metabolic acidosis rates were 0.66% (17 of 2 565) and 1.33% (33 of 2 484) in the CTG+ST and CTG-only groups, respectively [relative risk (RR) 0.50; 95% confidence interval (CI) 0.28-0.88; p=0.019]. The original mITT gave RR 0.47, 95%CI 0.25-0.86 (p=0.015), mITT with correction for 10 previously misclassified cases RR 0.48, 95%CI 0.24-0.96 (p=0.038) and per protocol analysis RR 0.40, 95%CI 0.20-0.80 (p=0.009). The level of significance of the difference in metabolic acidosis rates between the two groups remained unchanged in all analyses. Conclusion. Re-analysis of data according to the ITT principle showed that regardless of the method of analysis, the Swedish randomized controlled trial maintained its ability to demonstrate a significant reduction in metabolic acidosis rate when using CTG+ST analysis for fetal surveillance in labor.
PLOS ONE, 2020
Background Continuous intrapartum fetal monitoring is challenging and its clinical benefits are debated. The project evaluated whether short-term-variation (STV) and other computerised fetal heart rate (FHR) parameters (baseline FHR, long-term-variation, accelerations and decelerations) predicted acidaemia at birth. The aims of the study were to assess the changes in FHR pattern during labour and determine the feasibility of undertaking a definitive trial by reporting the practicalities of using the monitoring device, participant recruitment, data collection and staff training. Methods 200 high-risk women carrying a term singleton, non-anomalous fetus, requiring continuous FHR monitoring in labour were consented to participate from the Jessop Wing maternity unit, Sheffield, UK. The trans-abdominal fetal ECG monitor was placed as per clinical protocol. During the monitoring session, clinicians were blinded to the computerised FHR parameters. We analysed the last hour of the FHR and its ability to predict umbilical arterial blood pH <7.20 using receiver operator characteristics (ROC) curves. Results Of 200 women, 137 cases were excluded as either the monitor did not work from the onset of labour (n = 30), clinical staff did not return or used the monitor on another patient (n = 37), umbilical cord blood not obtained (n = 25), FHR data not recorded within an hour of birth (n = 34) and other reasons (n = 11). In 63 cases included in the final analysis, the computerderived FHR parameters did not show significant correlation with umbilical artery cord pH <7.20. Labour was associated with a significant increase in short and long term variation of