The Success of Cardiotocography in predicting Perinatal Outcome

Abstract

Objectives: The determination of the fetal condition during labor is important to minimize fetal death due to asphyxia and the neurological sequelae of fetal hypoxia. This study evaluated the success of fetal cardiotocography in predicting perinatal consequences. Materials and methods: This study enrolled 101 full-term pregnant women admitted for delivery to Vakif Gureba Training and Research Hospital between October 2009 and February 2010. Women were included if they were aged 18-45 years and within 36-41 weeks of gestation. During a 20-min period of fetal monitoring, a change in FHR (fetal heart rate) lasting for 15 s or two elevated runs of 15 beats was evaluated as a reactive NST (non-stress test). The umbilical artery pH was used as the “gold standard” for assessing fetal asphyxia. Results: The mean age of the women included in the study was 27.82 ± 5.29 years, the average parity was1.09 ± 0.96. The pH was normal in 85 neonates, while 13 had fetal asphyxia. No significant difference in umbilical cord blood pH, pO2, or pCO2 was observed between these two groups (p = 0.497, p = 0.722, and p = 0.053, respectively. No significant difference in maternal age, parity, or birth weight was found between the group with fetal distress based on CTG (cardiotocography) and the normal group. Conclusion: Cardiotocography is an important test during labor for labor management, it is insufficient for predicting the perinatal outcome. Therefore, labor should be evaluated on an individualized basis. J Clin Exp Invest 2012; 3(2): 168-171

Keywords

• Apgar score, blood gas analysis, caesarean section, cardiotocography

The Success of Cardiotocography in predicting Perinatal Outcome

Öz

Amaç: Doğum sırasında fetal koşulları belirlemek; asfiksi ve fetal hipoksideki nörolojik sekellere bağlı fetal ölümleri minimuma indirmek için önemlidir. Bu çalışmanın amacı, perinatal sonuçları öngörüde, fetal kardiyotokografinin başarısını değerlendirmektedir. Gereç ve yöntem: Bu çalışmaya Ekim 2009 ve Şubat 2009 tarihleri arasında Vakıf Gureba Eğitim ve Araştırma Hastanesinde doğum yapmayı kabul etmiş, 101 term gebe kadın alındı. 36-41 gebelik haftasında ve 18-45 yaşları arasındaki gebeler çalışmaya dahil edildi. 20 dakikalık fetal izlem periyodunda fetal kalp atımlarında en az iki adet; 15 saniye süren ve 15 atımlık artışları olan olgular, reaktif NST (Non-stress test) olarak kabul edildi. Umblikal arter pH fetal asfiksiyi değerlendirmede ‘altın standart\' olarak kullanıldı. Bulgular: Çalışmaya katılan kadınların ortalama yaşı 27.82 ± 5.29 ve ortalama pariteleri 1.09 ± 0.96 idi. 85 yeni doğanda pH normalken, 13 tanesinde fetal asfiksi görüldü. Bu iki grup arasında göbek kordon kanı (kök hücre kaynağı) pH, pO2, ya da pCO2 da anlamlı değişiklikler gözlenmedi (sırasıyla p = 0.497, p = 0.722, and p = 0.05). Kardiyotokografiye dayalı fetal distres ve normal grup arasında annelik yaşı, parite ya da doğum ağırlığında anlamlı derecede farklılık gözlemlenmedi. Sonuç: Kardiyotografi doğum yönetimi için doğum sırasında önemli bir testtir, ancak perinatal sonuçları öngörmek için yetersizdir. Bu yüzden doğum kişiselleştirmeye dayalı bir şekilde değerlendirilmelidir.

Anahtar Kelimeler

• Apgar skoru, kan gazlari analizi, sezaryen doğum, kardiyotografi

Kaynakça

1. Rouse DJ, Owen J, Goldenberg RL, Cliver SP. Deter- minants of the optimal time in gestation to initiate an- tenatal fetal testing: a decision-analytic approach. Am J Obstet Gynecol. 1995;173(5):1357-9.
2. Boylan P. Intrapartum fetal monitoring. Baillieres Clin Obstet Gynaecol 1987;1(1):73-95.
3. Steer PJ, Eigbe I, Lissauer TS, Beard RW. Inter- relationships among abnormal cardiotocogram in labor, meconium staining of the amniotic fluid, arte- rial cord blood pH and Apgar scores. Obstet Gynecol 1989;74(5):715-21.
4. Yucel A, Yilmazer M, Acar M. Comparison of doppler indices and non-stress test values according to fetal sex in normal term pregnancies. The Medical Journal of Kocatepe 2005; 6(1):19-24.
5. Thacker SB, Berkelman RL. Assessing the diagnos- tic accuracy and efficacy of selected antepartum fetal surveillance techniques. Obstet Gynecol Surv 1986;41(3):121-41.
6. Bretelle F, Le Du R, Foulhy C. Modality of fetal heart monitoring during labor (continuous or intermittent), telemetry and central fetal monitoring. J Gynecol Ob- stet Biol Reprod (Paris).. 2008; 37(1 Suppl): 23S-33S.
7. Keith RDF, Beckley S, Garibaldi JM et al. A multicen- tre comparative study of 17 experts and an intelligent computer system for managing labour using the car- diotocogram. Br J Obstet Gynaecol 1995;102(9):688- 700.
8. Schneider EP, Hutson JM, Petrie RH. An assessment of the first decade’s experience with antepartum fetal heart rate testing. Am J Perinatol 1988;5(2):34-41.

9. Phelan JP: The nonstress test: a review of 3,000 tests. Am J Obstet Gynecol 1981; 139(1):7-10.
10. Kidd LC, Patel NR, Smith R. Non stress antenatal car- diotocography: a prospective randomized controlled trial Br J Obstet Gynaecol 1985;92(11):1156-9.
11. Brown Y. Sawers RS, Parson RJ, Duncan SLB, Cooke ID. The value of antenatal cardiotocography manage- ment of high risk pregnancy: a randomized controlled trial. Br J Obstet Gynaecol 1982;89(9):716-22.
12. Visser GHA, Sadovsky G, Nicolaides KH. Antepar- tum heart rate patterns in small for gestational age third trimester fetuses: correlations with blood gas val- ues obtained at cordocentesis. Am J Obstet Gynecol 1990;162(3):698-703.
13. Smith JH, Anand KJ, Cotes PM, et al. Antenatal fetal heart rate variation in relation to the respiratory and metabolic status of the compromised human fetus. Br J Obstet Gynaecol 1988;95(10):980-9.