Admission test cardiotocography in labour as a predictor of foetal outcome in high risk pregnancies

Kumar, Anvesha; Jaju, P. B.

doi:10.18203/2320-1770.ijrcog20190981

Cited by 9 publications

(9 citation statements)

References 8 publications

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“…Bix et al analyzed three trials and found that the admission CTG was not effective in predicting neonatal outcomes [18]. [19][20][21][22]. Our study also backed the findings of these studies.…”

Section: Discussionsupporting

confidence: 84%

Admission Cardiotocography as a Predictor of Low Apgar Score: An Observational, Cross-Sectional Study

Nazir

Lakhta

Anees

et al. 2021

Cureus

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Background and objectiveCardiotocography (CTG) has been used more frequently in recent decades to reduce intrapartum fetal mortality rates. The purpose of this study was to determine whether pathological or non-reactive CTG could predict a low Apgar (Appearance, Pulse, Grimace, Activity, and Respiration) score. An abnormal trace would indicate a distressed fetus, whereas a normal trace would indicate a well-oxygenated fetus. MethodsThis study included a total of 470 women with a gestational period of more than 37 weeks. Based on the results of their CTGs, they were divided into three groups. An emergency cesarean section (CS) was performed if there was any sign of fetal distress on CTG. The Apgar scoring for newborns was recorded in the proforma following delivery. ResultsThe study was carried out at two major tertiary-care hospitals in Pakistan. A reactive CTG was found in more than one-third (39.36%) of the 470 patients. An Apgar score above 8 was obtained by 34.26% of the newborns, while an Apgar score below 8 was obtained by more than half (63.40%). Only 2.34% of newborns had an Apgar score below 6. A third (30.64%) of the patients had grade-1 meconium-stained liquor (MSL), 24.89% had grade-2 MSL, 19.79% had grade-3 MSL, and 24.68% had no MSL. One-third (32.34%) of the neonates were admitted to the neonatal intensive care unit (NICU) shortly after birth. When CTG was pathological or non-reactive, the odds of securing a higher Apgar score decreased by 70.45% (OR: 0.30; 95% CI: 0.20-0.44; p<0.001). ConclusionThe main conclusion drawn from this study's findings is that a pathological CTG is an indicator of a low Apgar score.

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Section: Discussionsupporting

confidence: 84%

Admission Cardiotocography as a Predictor of Low Apgar Score: An Observational, Cross-Sectional Study

Nazir

Lakhta

Anees

et al. 2021

Cureus

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“…Neonatal admission was higher in the pathological group, since only 7 (4%) fetuses with reactive CTG and 24 (18.4%) fetuses from the suspicious group compared to 53 (49.5%) fetuses from the pathological CTG group were admitted in NICU, thus, the difference was statistically significant with p-value <.05. A similar result was seen in the study conducted by Kumar et al [13], where 44.5% of babies with non-reactive CTG and 6% of babies with reactive CTG were admitted to the nursery. Atul K Sood et al [11] in their study found that there was a significant correlation between APGAR <7 and neonatal admission and was more commonly associated with non-reactive tracing, as 11.2% of babies with non-reactive CTG were admitted in NICU.…”

Section: Discussionsupporting

confidence: 87%

Role of Cardiotocography in predicting perinatal outcome in high-risk pregnancy

Jha,

Singh

2021

Ann Clin Anal Med

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Aim: In this study, it was aimed to evaluate the efficacy of fetal cardiotocography in predicting perinatal outcome. Materials and method: In this retrospective observational study, 400 gravid women with high-risk pregnancy fulfilling the eligibility criteria were enrolled. The results of CTG were studied according to NICE 2017 guidelines. Perinatal outcomes were studied by the color of liquor, Apgar score at one minute and five minutes, and NICU admission. Statistical analysis was done using a t-test and p-value <0.05 was considered statistically significant. Results: PIH was the most common risk factor in 32 % of females. CTG was reactive in 163(40.7%) patients and nonreactive (suspicious and pathological) in 237(59.2%) patients. One hundred thirty (54%) females with nonreactive CTG had meconium-stained liquor compared to only 18(11%) in the reactive group (p-value<0.05). In the reactive group, only 4% of babies had Apgar 5min <7 compared to 32.4% in the non-reactive group. Perinatal morbidity in the form of NICU admission was higher in the non-reactive group in 77 (32.4%) patients compared to 7 (4%) patients in the reactive group. The sensitivity and specificity of CTG for predicting neonatal morbidity were 63% and 80.4%, while it's PPV and NPV were 49.4% and 89.4%, respectively. Discussion: CTG has shown high specificity and negative predictive value for detecting adverse perinatal outcomes in this study. This appears to be a simple, non-invasive test that can serve as a screening tool to detect fetal distress that is already present or likely to develop during labor in high-risk obstetric patients in centers with a heavy workload.

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“…Similar results were reported in several other studies. 6,11,15,17 A higher incidence of LSCS for foetal distress was observed in high risk patients (25%) compared to low risk patients (2%) in the present study. This is probably the result of misclassification of more foetuses as suspicious or pathological AT (high false positives).…”

Section: Atmentioning

confidence: 42%

“…In the present study, the proportion of patients with a reactive AT, suspicious AT, and pathological AT were comparable to results in similar studies. 5,6,[11][12][13] The shortcomings of a single AT in predicting foetal distress in the setting of protracted labour and problems of cord have been described in several studies. 5,[12][13][14][15] Foetal distress was present in 11 (7.05%) patients with a normal AT in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…These findings are consistent with those reported in several other studies Table 6. 6,11,17,18 An abnormal FHR tracing is a sensitive indicator that distress exists, but the intrinsic predictive value of such a tracing is disappointingly low because of the large number of false positive results. 19 Due to the high specificity and NPV of the AT, when a test is negative, a clinician can be sure that adverse foetal outcomes will be infrequent for the next few hours (5-6 hours) of labour and the patients can be confined to monitoring by IA.…”

Section: Atmentioning

confidence: 99%

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Labour Admission Test - A low cost alternative to predict foetal distress and neonatal outcomes

Chinta¹,

Sarvamangala²

2020

JCBS

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Background and Objectives: The aim of various antepartum and intrapartum monitoring methods is to detect foetal hypoxia at the earliest and to prevent subsequent damage. Cardiotocography (CTG) is one of them. Routine and continuous EFM in labour is not possible in developing countries with limited resources and manpower. Objective of the study was to evaluate the role of CTG as admission test (AT) to predict foetal outcome in low and high-risk group. Methods: The study population consisted of 100 low risk and 100 high risk patients at term in labour admitted at WCH Hospital attached to J.J.M Medical College, Davangere. Patients were subjected to admission CTG for 20 minutes. The trace thus obtained was classified as normal, suspicious and pathological AT as per NICE 2017 Guidelines on Intrapartum Care. Results: Among the study group of 200 cases, including low and high-risk groups, 156 (95 & 61) cases had normal AT, 29 (5 & 24) cases had suspicious and 15 high risk cases had Pathological AT. The incidence of foetal distress, caesarean rate, Apgar score at 5 minutes less than 7, NICU admission was higher in pathological AT group than in normal AT. A statistical analysis comparing normal and abnormal (suspicious + pathological) AT showed high specificity 83.82% and high negative predictive value 92.95%. However, LAT was found to have low sensitivity 59.26% and low positive predictive value 36.36%. Conclusion: CTG as LAT is a simple, non-invasive, low cost test with high specificity and NP, that can be used to triage patients at the outset, thereby utilizing the limited equipment and staff effectively in resource poor labour wards. Keywords: Labour Admission Test, Cardiotocography, Perinatal Outcome, Electronic Fetal Monitoring

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Admission test cardiotocography in labour as a predictor of foetal outcome in high risk pregnancies

Cited by 9 publications

References 8 publications

Admission Cardiotocography as a Predictor of Low Apgar Score: An Observational, Cross-Sectional Study

Admission Cardiotocography as a Predictor of Low Apgar Score: An Observational, Cross-Sectional Study

Role of Cardiotocography in predicting perinatal outcome in high-risk pregnancy

Labour Admission Test - A low cost alternative to predict foetal distress and neonatal outcomes

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