The intrapartum CTG prior to neonatal encephalopathy at term: a case‐control study

Spencer, John; Badawi, Nadia; Burton, Paul R.; Keogh, John; Pemberton, Patrick J.; Stanley, Fiona

doi:10.1111/j.1471-0528.1997.tb10643.x

Cited by 89 publications

(48 citation statements)

References 13 publications

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“…As a crude risk factor, it is even more predictive than an abnormal intrapartum cardiotocograph 6 . In the United States collaborative perinatal project, more than half of such babies died or developed disability 7 .…”

Section: Discussionmentioning

confidence: 99%

Fever in labour and neonatal encephalopathy: a prospective cohort study

Impey

Greenwood

MacQuillan

et al. 2001

BJOG

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Objective To determine whether the reported association of maternal fever with neonatal encephalopathy is independent of other associated intrapartum risk factors.Design Prospective cohort study.Setting Dublin teaching hospital delivery ward. Population 4915 low risk women in labour at 36-41 weeks of gestation.Methods Using logistic regression with odds ratios and 95% con®dence intervals, the incidence of neonatal encephalopathy and other neonatal outcomes of women who had an intrapartum fever .37.58 C was compared with those who did not.Results The cohort comprised 33% of all deliveries during the study period. Neonatal encephalopathy was diagnosed in 3.25/1000 births. The incidence of intrapartum fever was 6.8%. Maternal fever was strongly associated with neonatal encephalopathy (crude OR 10.8, 95% CI 4.0-29.3). Univariate analysis showed maternal fever was associated with epidural analgesia, nulliparity, induction, longer labour, oxytocin administration, greater fetal birthweight and gestational age and instrumental vaginal delivery, but not with prolonged (.24hours) prelabour rupture of the membranes. The association of fever with neonatal encephalopathy persisted having adjusting for these covariates (adjusted OR 4.72, 95% CI 1.28-17.4). Conclusions The relationship between maternal intrapartum fever and neonatal encephalopathy is independent of other known intrapartum risk factors. This provides further evidence for the role of in¯ammatory processes in the aetiology of neonatal neurological morbidity.

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Section: Discussionmentioning

confidence: 99%

Fever in labour and neonatal encephalopathy: a prospective cohort study

Impey

Greenwood

MacQuillan

et al. 2001

BJOG

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“…Today, the FIGO classification [2] is frequently used since a correlation was found between pathological classified FIGO CTGs and fetal outcome (evidence level IIa) [6]. …”

Section: Introductionmentioning

confidence: 99%

Intra- and Interobserver Variability of Intrapartum Cardiotocography: A Multicenter Study Comparing the FIGO Classification with Computer Analysis Software

Schiermeier

Westhof

Leven³

et al. 2011

Gynecol Obstet Invest

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Objective: To evaluate and compare the computer analyzing software system with subjective interpretation using the FIGO classification of intrapartum cardiotocograms. Methods: Twenty-four obstetricians and 19 midwives from 3 hospitals [19 junior (≤3 years) and 24 senior (>3 years) experience] participated in this study. Forty-three doctors and midwifes interpreted intrapartum cardiotocographic (CTG) readings from 12 parturients without knowing the clinical outcome. Two CTG readings were repeated for evaluation of the intraobserver variability. Inter- and intraobserver agreement in CTG interpretation using the FIGO score and the computer analyzing software was assessed via proportions of agreement (Pa), with 95% confidence intervals. The level of inter- and intraobserver agreement was analyzed by calculating Pa values for CTG baseline, variability, accelerations and decelerations. Results: In total, for all parameters of the FIGO classification, Pa was very low. The highest 95% confidence level of Pa was found for the baseline parameter (0.49–1.01), and the lowest for the parameter acceleration. No significant difference was seen between obstetricians and midwifes as well as between junior and senior experience. In assessments of normal cases, the Pa were significantly higher than in pathological readings. Conclusion: Computer analyzing software can reduce the high inter- and intraobserver variability; however, further studies are needed to find out whether this can improve fetal outcome and reduce the number of Cesarean sections.

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“…30 In our study, all of the asphyxiated cases with a poor neurological outcome had abnormal CTG, but only half of them had clear pathological recording, while the other half had a CTG of only moderate, 'non-reassuring' classification. At the same time, half of the asphyxiated cases with normal outcome had pathological CTG, and also half of the nonasphyxiated control cases had abnormal CTG.…”

Section: Discussionmentioning

confidence: 88%

Obstetric parameters and Doppler findings in cerebral circulation as predictors of 1 year neurodevelopmental outcome in asphyxiated infants

et al. 2011

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Objective: To establish the association of cardiotocography (CTG) and other obstetric parameters with pulsed Doppler findings in cerebral arteries during the first day of life, and to compare the cerebral artery Doppler with other determinants of asphyxia in predicting 1-year neurological outcome in asphyxiated full-term infants.Study Design: Cerebral blood flow velocity (CBFV) were measured from the anterior cerebral (ACA) and basilar (BA) arteries in 30 asphyxiated and 30 healthy-term infants using pulsed Doppler ultrasonography at approximately 24 h of age. CTG, cord artery pH, Apgar scores, biochemical asphyxia markers and symptoms of hypoxic-ischemic encephalopathy (HIE) were compared with the Doppler findings in respect of the ability to predict the outcome, defined by death or impaired neurological performance at 1 year of age.Result: In all, 20% of the asphyxiated infants but none in the control group had increased peak systolic CBFVs (mean þ 3 s.d.) in the ACA or BA. The sensitivity of increased systolic CBFV to predict abnormal outcome in the asphyxia group was 83%, specificity 95% and the sensitivity of the combination of HIE grade from 2 to 3 and increased systolic CBFV in the ACA or BA was 100% and specificity was 95%, respectively. Pathological CTG and low cord artery pH or low Apgar scores showed low predictive power. Conclusion:Grade from 2 to 3 HIE and the systolic CBFV (mean þ 3 s.d.) in the ACA or BA by Doppler ultrasound seemed to predict the outcome in asphyxiated infants at 1 year of age better than CTG, acid basement status, Apgar scores or asphyxia markers. If an increase of more than þ 3 s.d. in the systolic CBFV does not occur within the first 24 h of life, a good 1-year neurological outcome may be anticipated.

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The intrapartum CTG prior to neonatal encephalopathy at term: a case‐control study

Cited by 89 publications

References 13 publications

Fever in labour and neonatal encephalopathy: a prospective cohort study

Fever in labour and neonatal encephalopathy: a prospective cohort study

Intra- and Interobserver Variability of Intrapartum Cardiotocography: A Multicenter Study Comparing the FIGO Classification with Computer Analysis Software

Obstetric parameters and Doppler findings in cerebral circulation as predictors of 1 year neurodevelopmental outcome in asphyxiated infants

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