TITLE:
Admission Cardiotocography: Its Role in Predicting Perinatal Outcome in Term, Uncomplicated (Low Risk) Pregnant Women in Spontaneous Labour
AUTHORS:
Edirisuriye Arachchige Dilan Tharindu
KEYWORDS:
Admission Cardiotocography, Apgar Score, NICU, Meconium
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.13 No.3,
March
24,
2023
ABSTRACT: Introduction: Labour admission cardiotocography (CTG) is commonly
used non-invasive method of fetal monitoring in Sri Lanka. It may have a
potentialto predict perinatal outcome in low-risk term pregnancies. Objectives: Objectives of the study were to determine the
perinatal outcomes of normal, suspicious and pathological admission CTGs and
role of labour admission cardiotocography as a predictive test for perinatal outcome
in low-risk term pregnancies in spontaneous labour. Methods: This study was a prospective observational study
done involving 445 low risk, term pregnancies in spontaneous labour. Labour
admission CTG was performed in each pregnancy and categorized into normal,
suspicious and pathological CTG according to criteria depicted by National
Institute of Clinical Excellence (NICE) guideline 2007. Apgar score less than 7
at five minutes, resuscitation at birth, admission to neonatal intensive care
unit (NICU),
seizure within first 24 hours of birth and meconium-stained amniotic fluid were
the primary outcome measures to assess fetal asphyxia. Mode of delivery in each
category, nuchal cord at birth were also assessed. Results: Majority of participants were in 25-to-29-year age
group and were nulliparous. Frequencies of normal, suspicious and pathological
CTG were 74.8%, 18% and 7.2% respectively. Pathological CTG was significantly
associated with low Apgar score compared to non-pathological CTG group (p 0.005) while other outcome measures were not
significant. Rate of operative delivery was 68% in pathological group and 20.8%
in non-pathological CTG group. Sensitivity,
specificity, positive predictive value (PPV)
and negative
predictive value (NPV) of labour admission CTG to detect fetal asphyxia were 51.85%, 95.69%, 43.75% and
96.85% respectively. Conclusions: Incidence of pathological labour admission CTG was 7.2%. Apgar score
less than 7 at five minutes of birth was significantly associated with
pathological CTG group compared to non-pathological CTG (p 0.05). Worsening of CTG from normal to pathological
showed increasing rate of operative delivery. Even though sensitivity and
positive predictive values of labour admission CTG were low, specificity and
negative predictive values were high for detecting low Apgar score. Therefore, labour admission CTG has a
value in excluding adverse perinatal outcomes in low-risk term pregnancies in spontaneous labour.