Abstract

ABSTRACT Background: Cardiotocography is widely used as a method of fetal monitoring. Aims: To determine the accuracy of non-reassuring and abnormal cardiotocography (CTG) in assessing fetal hypoxia in emergency cesarean sections; And also to correlate these non-reassuring and abnormal CTGs with intraoperative findings and perinatal outcome. Methods: This was a prospective, observational study including ninety eight singleton pregnancies of >34 weeks of gestation who underwent emergency cesarean section for non-reassuring or abnormal CTG. Immediately after delivery of the baby, umbilical arterial blood was analyzed for pH. Fetal hypoxia was diagnosed if umbilical cord blood pH was ≤ 7.2. Neonates were assessed in terms of APGAR scores at 1 and 5 minutes of life, need for resuscitation, ventilator support, NICU admission and neonatal mortality. Results: Among the studied cases (n = 98), 56 (57.1%) had non-reassuring and 42 (42.9%) had abnormal CTG. Non-reassuring and abnormal CTG had pH range of 7.14-7.48 and 6.93-7.49 respectively and mean pH with SD of 7.339 ± 0.075 and 7.299 ± 0.11 respectively. Positive Predictive Value (PPV) of non-reassuring and abnormal CTG for fetal hypoxia were 8.93% and 11.9% respectively with overall PPV of 10.2%. However, 76.5% of cases did have positive intraoperative finding that could explain possibility of fetal distress. Conclusion: Non-reassuring or abnormal CTG alone did not accurately predict fetal hypoxia or adverse perinatal outcome.

Authors: Amrit Pokharel, Geeta Gurung, Josie Rana Baral, Suchana Dhital
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