“Evaluation of Cardiotocography (Ctg) Monitoring For Intrapartum Foetal Surveillance and Its Correlation with Apgar Score”
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2018, Vol 17, Issue 6
Abstract
.Background and objectives: in past, mother and child are considered as one unit. Today fetus is no longer considered a maternal appendage, but it has got a separate status for its care as fetus faces faces greater risk of mortality and morbidity. Cardiotocography was incorporated in clinical obstetrics to reduce intrapartum mortality and morbidity.intrapartum monitoring has infact improved fetal outcome and normal survival is now possible in cases considered hopeless years ago. cardiotocography is a simple, safe, non invasive and economical investigation which can be done on every patient in labour. This test should be a part of intrapartum fetal surveillance. The abnormal pattern are recognized and necessary and timely intervention is done, thereby saving mother and fetus. Hence this topic has been taken to evaluate the perinatal outcome following the early recognition of abnormal CTG and early intervention made. Objective: the main goal of the study was to correlate abnormal cardiotocography and perinatal outcome and. To formulate the plan of acton depending on the result and to study the outcome of pregnancy.to reduce perinatal mortality and morbidity by including cardiotocography as an routine investigation during vaginal delivery. Method: the present study is a simple random sampling which includes minimum of 100 term pregnant women in labour with in a period of 15 months with abnormal cardiotography admitted in the Niloufer hospital, Hyderabad all women in active labour with singleton, term pregnancy, with cephalic presentation CTG tracings were taken, preferably 30 minutes before delivery or even earlier with FHR irregularities. CTG tracing were defined as non-reassuring and abnormal patterns as per NICE guidelines 2016. Reassuring patterns were excluded from the study. After delivery apgar score at 1 and 5 minutes were taken. NICU admission were analyzed and followed up till discharge. twin pregnancies, eclampsia, antepartum haemorrhage, preterm deliveris were excluded from the study. Results: among the 100 patients 48(48%) showed nonreassuring FHR patterns, 52(52%) showed abnormal FHR patterns. Variable decelerations were commonest abnormal CTG patterns and seen in 32% of cases, next common was tachycardia in 32%, bradycardia in 30%, late deceleration in 22%, 27% of cases delivered vaginally, among them 19% were in the non-reassuring FHR group. Operative interventions were done in 73(73%) of them 55(55%) with caesarean deliveries and 18(18%) with instrumental deliveries. 1 min apgar score <7 (depressed) was 29.16% and 40.38% in non-reassuring and abnormal groups respectively with sensitivity of 90%, specificity of 19%, positive predictive value 69% and negative predictive value 97.3% 5 min apgar score <7 were 7% and 12% in non-reassuring and abnormal groups respectively with sensitivity of 77%, specificity 60%, positive predictive value 12.7% and negative predictive value 97%.admission to NICU were 13% and !*% in non-reassuring and abnormal FHR groups and 4 in instrumental vaginal delivery and 7 in vaginal delivery. Conclusion: Abnormal CTG predicts the fetal outcome, ie poor Apgar score at 1 min and 5 minutes, increased rate of caesarean section and neonatal resuscitation. CTG is an important test to assess the fetal condition in intrapartum period. The sensitivity of CTG was 96%, specificity was 63%, positive predictive value was 22% and negative predictive value was 99% in the prediction of abnormal outcomes. In spite of increased operative delivery there was decreased rate of NICU admissions and neonatal deaths providing that early intervention esuscitation and will improve neonatal out come. Here by I conclude that continuous EFM should be offered and recommended for highrisk pregnancies where there is an increased risk of perinatal death.
Authors and Affiliations
Dr. K. Sowmya, Asst. Professor, Dr. G. Anusha,Senior Residentdr, Vijaya Krishna Associate Professor
Keywords
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