Reliability of admission cardiotocography for intrapartum monitoring in low resource setting

Abstract

BackgroundTo evaluate the role of admission cardiotocography in intrapartum patients in detecting fetal hypoxia already present and to correlate the results of admission cardiotocography with perinatal outcome.Materials and Methods:It was a cross-sectional study conducted in the Labor and Maternity ward during the period 2007-2009. The study included 176 pregnant women (both high risk and low risk), admitted to the emergency department or through the outpatient department with period of gestation ≥36 weeks, in first stage of labor with fetus in cephalic presentation. All of them were subjected to an admission test, a 20 min recording of fetal heart rate and uterine contractions on cardiotocograph machine at the time of admission.Results:The results of the admission test were ‘reactive’ in 82.38%, ‘equivocal’ in 10.22%, and ‘ominous’ in 7.38% women. Women with the reactive admission test had low risk of intrapartum fetal distress (6.9%) as compared to 39.9% in the equivocal and 84.6% in the ominous group (P<0.001). Incidence of moderate to thick meconium stained liqor were more in ominous (61.5%) and equivocal group (33.3%) in compared to reactive group (4.8%) (P<0.001). Incidence of NICU admission was also significantly high (62%) in babies delivered from mother with ominous test group compared to those with equivocal (28%) and reactive test (3.45%) group babies. Neonatal mortality was also seen in babies born to mothers with equivocal (5.5%) and ominous (7.6%) admission test groups. Operative delivery for fetal distress was required in only 5.5% (8 of 145) woman of the reactive group, in 27.8% (5 of 18) woman of the equivocal group and in 84.6% (11 of 13) women of the ominous group.Conclusion:The admission cardiotocography is a simple non-invasive test that can serve as screening tool to detect fetal distress already present or likely to develop and prevent unnecessary delay in intervention. The test has high specificity and can help in ‘triaging’ fetuses in obstetric wards of developing countries with a heavy workload and limited resources.

Admission Cardiotocography in High Risk Pregnancies

“…Thus the above finding suggests that babies from reassuring CTG required less resuscitation and NICU admission. The findings were similar with the study done by Rahman et al 16 where incidences of NICU admission was significantly high in babies delivered from mother with ominous test group (62%) compared to those with equivocal test group (28%) and reactive test group (3.45%). In study by Sandhu et al 22 neonatal admission to NICU was required in 1% of cases with a reactive AT, 12% of cases with an equivocal AT and 33% of cases with an ominous AT (p<0.01).…”

“…In ominous AT group of 14 cases, 2(14.3%) had normal vaginal delivery, 11(78.6%) had LSCS and 1(7.1%) had instrumental delivery. The study by Rahman 16 showed that operative delivery for fetal distress was required in only 5.5% women of the reactive group, in 27.8% of equivocal group and in 84.6% of the ominous group. The low percentage of operative deliveries in reactive and equivocal groups may be because the cases with equivocal trace were placed on continuous CTG monitoring.…”

“…In ominous AT group, 50% and 31.3% of the patients had moderate and thick meconium stained liquor. In a cross-sectional study conducted by Rahman et al 16 among 176 pregnant women (both high and low risk), the incidence of moderate to thick meconium stained liquor were more in ominous group (61.5%) and equivocal group (33.3%) in compared to reactive group (4.8%). It was statistically significant with p-value <0.001.…”

Amniotic fluid index, non-stress test and color of liquor: as a predictor of perinatal outcome

“…17 In the study by Shreshtha P et al Cat.-I is 77%, Cat.-II 9%) and Cat.-III 20% while in the study by Rahman H et al; Cat.-I is 77.0%, Cat.-II 14%) and Cat.-III 9%. 18,19 Observation regarding color of liquor found to be comparable to studies by Becker S, where prevalence was 10%, Ziadeh SM et al also had prevalence of 11%, while Maymon E et al in the study had 17% prevalence and Nathan et al in their study had prevalence of 20%. [21][22][23] In the oligohydramnios (<5 cm) group, there was significant association with pathological NST at admission, meconium stained liquor during Labor, caesarean delivery for fetal distress, newborn APGAR at 1 minute <7, NICU admission and newborn mortality ('p' value <0.00001) ( Table 2).…”

“…In a similar study by Rahman H et al 19 Cat.-I had 11% intervention, Cat.-II had 39% needed intervention, and Cat.-III had 86% needed intervention (LSCS). In the study Sandhu et al, 15% intervention in Cat.-I NST 55% intervention in Cat.-II and 73% intervention in Cat.-III NST.…”