Intrapartum cardiotocographic monitoring and its correlation with neonatal outcome

Suraj Kumar Singh; Rakesh Kumar; Anand Agarwal; Amita Tyagi; Surender Singh Bisht

doi:10.4103/jfmpc.jfmpc_1525_22

Intrapartum cardiotocographic monitoring and its correlation with neonatal outcome

J Family Med Prim Care. 2022 Nov;11(11):7398-7405. doi: 10.4103/jfmpc.jfmpc_1525_22. Epub 2022 Dec 16.

Authors

Suraj Kumar Singh¹, Rakesh Kumar², Anand Agarwal³, Amita Tyagi³, Surender Singh Bisht³

Affiliations

¹ Department of Neonatology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India.
² Department of Pediatrics, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India.
³ Department of Pediatrics, Swami Dayanand Hospital, Delhi, India.

Abstract

Introduction: Despite the advancements in perinatal care in past decades, perinatal asphyxia remains a serious problem leading to significant perinatal morbidity and mortality. Therefore, foetal monitoring during the intrapartum period is of paramount importance. Among various methods of fetal monitoring, cardiotocography is a form of electronic foetal monitoring in which there is simultaneous recording of foetal heart rate and uterine contractions.

Materials and methods: This cross-sectional observational study was done in the labour room and neonatal intensive care unit (NICU) of a teaching Municipal Hospital in North India including 500 pregnant women of age group 18-45 years with singeleton fetus of gestation ≥36 weeks without any known congenital anomaly. Intrapartum cardiotocography (CTG) for 20 minutes was done within 12 hours prior to delivery and babies born to them were observed for birth asphyxia as Apgar score <7 at 1 minute as per using APGAR score less than 7 at 1 minute as per south east asia regional neonatal perinatal database (SEAR-NPD), world health organization (WHO) working definition.

Results: CTG tracing was normal/reassuring in 92% of pregnant women, nonreassuring in 7% and was abnormal in only 1%. In patients with abnormal and nonreassuring CTG, delivery by lower segment cesarian section (LSCS) was significantly high (P < .0001). APGAR scoring was done at 1 minute and 5 minutes of life, it was found that 4% babies were having score less than 7 at 1 minute with incidence of birth asphyxia 40 per 1,000 live births Neonatal seizure was significantly more in nonreassuring and abnormal CTG group (P value <.0001).

Conclusion: Abnormal CTG tracings result in higher incidence of operative interventions for deliveries. Abnormal CTG pattern during intrapartum CTG has high specificity and negative predictive value but has low sensitivity and positive predictive value for detection of birth asphyxia and need for NICU admission.

Keywords: Birth asphyxia; Thompson score; intrapartum cardiotocography; neonatal seizure.