Birth asphyxia and the intrapartum cardiotocograph

Abstract

Summary. The intrapartum cardiotocographs (CTGs) of 38 severely asphyxiated, term infants, born during a 17‐month period, and those of 120 healthy term infants acting as controls were independently reviewed by three investigators who were unaware of the clinical outcome. Interobserver agreement was good (Kappa statistic = 0.74, P<0.0001). The investigators found that cardiotocographic abnormalities were present in 33 of the asphyxiated infants (87%) and in 35 of the controls (29%) and predicted that the abnormalities were severe enough to lead to significant fetal metabolic acidosis at delivery in 23 asphyxiated infants (61%) and in 11 controls (9%). The differences between the two groups were highly significant (P<0.001). Using the traditional diagnostic criteria for fetal distress, the investigators found that fetal blood sampling was indicated in 58% of cases in the asphyxia group and in 20% of controls but was only performed in 16% of asphyxiated infants and in 8% of controls. Furthermore, the median response times of delivery suite staff for abnormal fetal heart rate patterns were similar whether the FHR changes, classified using Krcbs' CTG scoring system, were moderate or severe: 80 min and 90 min, respectively. These findings suggest that interpretation of the intrapartum CTG continues to pose major problems for practising obstetricians.

European Community Multi-Center Trial “Fetal ECG Analysis During Labor”: ST plus CTG analysis

“…It is among these "missed" cases we should expect cases of intrapartum asphyxia. Once a pattern has not been recognized as abnormal it is most likely that pattern will continue to be unrecognized and labor allowed to progress (11). Thus, it is not surprising to find four cases of intrapartum asphyxia not being acted upon.…”

Inter‐ and intra‐observer agreement of intrapartum ST analysis of the fetal electrocardiogram in women monitored by STAN

“…3 For several reasons, however, FBS is not widely applied. 1,[4][5][6] A relatively new method for continuous fetal monitoring is the STAN methodology (Neoventa Medical, Gothenburg, Sweden) in which (classification of) the CTG is combined with ST analysis of the fetal electrocardiogram (ECG). Abnormalities in the ST segment of the fetal ECG are related to metabolic acidosis of the fetus.…”

Wertigkeit präpathologischer und pathologischer Dopplerbefunde im Vergleich zu CTG, Hormon- und Asphyxieparametern

“…Die präpartale Routinekardiotokographie weist in Hinblick auf eine IUGR-Erkennung auch bei Vergrößerung des als suspekt zu wertenden Grenzbereiches keine ausreichende Sensitivität auf. Der Stellenwert dieser Methode liegt in der Asphyxieerkennung bei intrapartaler Anwendung [7]. Im Hochrisikokollektiv mit enddiastoli schem Flußverlust läßt nach den eigenen Ergebnissen das Auftreten eines Reverse-Flow eine signifikante Erhöhung der Aziditätssteigerung erwar ten und ist der Kardiotokographie in der Spezifität deutlich überlegen.…”