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Tive Findings and Neonatal Outcome in Caesarean Section for Non Singh AC et al. CTG and neonatal outcome in CS NJOG. Jan-Jun. 2021;16(32):61-64 Original Correlation of Cardiotocography with Intraopera- tive findings and neonatal outcome in caesarean section for non-reassuring fetal status Arju Chand Singh, Ratna Khatri, Pradyuman Chauhan, Sumana Thapa Department of Obstetrics and Gynecology, Shree Birendra Hospital, Kathmandu, Nepal ABSTRACT Aims: To demonstrate the correlation of cardiotocography with intraoperative CORRESPONDENCE findings and neonatal outcome undergoing emergency cesarean section for non -reassuring fetal status. Dr Arju Chand Singh Methods: It is a hospital based cross sectional study at maternity ward of Shree Department of Obstetrics Birendra Hospital in Kathmandu with non-reassuring CTG who underwent ce- and Gynecology, Shree Birendra Hospital, sarean section in a period of one year. Their CTG were correlated with their intraoperative findings and neonatal outcome such as meconium stained liquor, Kathmandu, Nepal nuchal cord, Apgar score at birth, NICU admission, perinatal mortality and stillbirth. E-mail: Results: Fifty four patients were recruited. Most common operative finding [email protected]; was meconium stained liquor (35.2%); and cardiotocographic abnormality was Phone: +977-9801020444 variable Deceleration (37%). Variable deceleration and late deceleration had significant correlation with meconium stain liquor and nuchal cord. Apgar Received: March 25, 2020 score ≤ 7 at 5 minute was 7.4%. NICU admission was 13% with common ab- Accepted: May 1, 2021 normality as late Deceleration. Citation: Conclusion: CTG pattern of variable and late deceleration had correlated with Singh AC, Khatri R, Chau- the meconium stained liquor and nuchal cord only. There was no relation with han P, Thapa S. Correlation neonatal outcome in terms of Apgar score and admission rate. of Cardiotocography with Keywords: Apgar, cardiotocography, cesarean section, meconium stained liq- Intraoperative findings and uor, non-reassuring neonatal outcome in caesar- ean section for non- reassuring fetal status. Nep INTRODUCTION to fetal hypoxia /acidosis.3 J Obstet Gynecol. 2021;16 (32):61-64. DOI: https:// Fetal surveillance is very important Not all fetuses with abnormal doi.org/10.3126/ 1 for the delivery of healthy baby. Car- fetal heart pattern have adverse njog.v16i1.37521 diotocography (CTG) record shows perinatal outcome. It is 20 mi- fetal heart rate changes and its rela- tionship to uterine contractions which nute recording of fetal heart and is helpful in detecting fetal distress.2 uterine contraction by using Caesarean section rates are rising in CTG machine in labour ward as trend. One of the most common caus- it is very simple, noninvasive es for caesarean section is fetal dis- and quick.4 CTG may identify tress. Widespread use of CTG may abnormal fetal heart rate pattern risk increasing the rate of Caesarean as the presumptive sign of fetal section. Continuous CTG monitoring distress at the cost of rising Ce- should be done when abnormalities sarean section because the false are detected during intermittent fetal 5,6,7 positivity reaches to 50-80%. auscultation and in cases of high A Cochrane Collaboration review risk pregnancy which are prone to has shown that use of CTG reduces 61 Singh AC et al. CTG and neonatal outcome in CS NJOG. Jan-Jun. 2021;16(32):61-64 Original the rate of seizures in the newborn but there is no RESULTS clear benefit in the prevention of cerebral palsy, per- Total number of 1132 women delivered during the inatal death and other complications of labour. The- study period. Out of these 54 women underwent se abnormal CTG traces may or may not be related emergency cesereasn section for nonreassuring to intraoperative findings of meconium stained liq- CTG. The mean age of the women in the study uor or low Apgar at birth or nuchal cord. Many fe- group was 21-25 years (44.4%) followed by 26 to tuses show heart rate changes without showing poor 30 years (25.9%) and 31 to 35 years (25.9%) re- outcome and CTG has been criticized for unneces- spectively; 57.4% were multiparous and 42.6% sary increase in rate of operative deliveries.8,9,10 . primiparous. Most common operative findings Hence the purpose of this study is to observe the were presence of meconium stained liquor (35.2%) relationship of CTG with post-cesarean fetal out- followed by Nuchal cord (24.1%), less liquor vol- come. ume (14.8%) and antepartum hemorrhage (5.6%). METHODS There was no apparent cause in 18.5%. Common CTG findings were variable deceleration (37%), It is a hospital based cross sectional study of women late deceleration (24.1%), tachycardia (20.4%) and admitted in maternity postoperative ward of Shree persistent bradycardia (18.5%). Meconium stained Birendra Hospital (SBH) with non-reassuring CTG liquor and nuchal cord were statistically significant who underwent cesarean section fulfilling inclusion for variable and late deceleration of fetal heart ab- criteria in a period of one year from December 2019 normality. [Table-1] to December 2020. All Cesarean sections performed for non-reassuring CTG in singleton live term preg- NICU admission was 13% which was more com- nancies with cephalic presentation were taken; and mon with late deceleration (42.9%) followed by congenital anomalies were excluded. Written in- persistent bradycardia (28.6%) and variable decel- formed consent was taken after ethical approval. eration (28.6%). Apgar score ≤7 at 5 minute was Fetal heart tracing was recorded for a period of 20 7.4% which was more common with late decelera- minutes. Maternal age, parity, associated risk factors tion of fetal heart abnormality followed by persis- and abnormal fetal heart rate patterns in terms of tent bradycardia and variable deceleration. NICU FHR, baseline variability, acceleration and decelera- admission rate and Apgar score were not statisti- tion were recorded. Neonatal outcome recorded in cally significant. There was no perinatal mortality. terms of one and five minute Apgar score, birth Meconium stained liquor was the most common weight, NICU admission, stillbirth and perinatal operative finding with late deceleration and NICU mortality. Patients were followed till discharge. In- admission. [Table-2] traoperative findings like meconium stained liquor, DISCUSSION antepartum hemorrhage, nuchal cord and decreased liquor volume were also recorded. Chi squared test Many studies have been undertaken to study the was done using SPSS data sheet. importance of CTG monitoring. In our study out of 54 enrolled cases, majority belonged to age group 21 to 25 years(44.4%) which correlated with the Table-1: Correlation of fetal heart abnormality with intraoperative findings (N=54) Finding MSL NC APH Oligo AN No Yes p-value No Yes p-value No Yes p-value No Yes p-value No Yes p-value No 27 17 32 12 42 2 38 6 38 6 PB 0.265 0.249 0.497 0.609 0.053 Yes 8 2 9 1 9 1 8 2 6 4 No 16 18 31 3 32 2 31 3 26 8 VD 0.00 0.00 0.89 0.106 0.216 Yes 19 1 10 10 19 1 15 5 18 2 No 35 6 28 13 38 3 33 8 31 10 LD 0.00 0.02 0.32 0.084 0.049 Yes 0 13 13 0 13 0 13 0 13 0 No 27 16 32 11 41 2 36 7 37 6 Tac 0.538 0.608 0.566 0.549 0.088 Yes 8 3 9 2 10 1 10 1 7 4 PB-Persistent bradycardia, VD-Variable deceleration, LD-Late deceleration, Tac-Tachycardia, MLS- Meconium stained liquor, NC-Nuchal cord, APH-Antepartum hemorrhage, Oligo-Less liquor volume, AN- Apparently normal 62 Singh AC et al. CTG and neonatal outcome in CS NJOG. Jan-Jun. 2021;16(32):61-64 Original Table-2: Correlation of CTG with Neonatal outcome Finding NICU admission Apgar in 1 min Apgar in 5min No Yes p-value AS<7 AS≥7 p-value AS<7 AS≥7 p-value CTG No 39 5 0.463 22 22 0.252 3 41 0.729 PB Yes 8 2 3 7 1 9 No 29 5 14 20 3 31 VD Yes 18 2 0.619 11 9 0.325 1 19 0.604 No 37 4 17 24 2 39 LD Yes 10 3 0.213 8 5 0.206 2 11 0.208 No 36 7 22 21 4 39 Tac Yes 11 0 0.151 3 8 0.156 0 11 0.293 PB-Persistent bradycardia, VD-Variable deceleration, LD-Late deceleration, Tac-Tachycardia study done by Joshi et al11 (55%) and Rahman et cord was reported by Bhatia19 (47.1% and 33.3%) al12 (42.5%) whereas in the study by Kansal et al13 and Mittal et al20 (46.6% and 41.1%) than our 44% belonged to age group 26 to 30 years; 42.6% study. of the patients were primigravid while 57.4% were 21 Kumar et al correlated abnormal CTG findings multigravid which were comparable with the study with meconium stained liquor in 86.3% whereas in done by Kumar VR et al (56% and 44%) and Rana 20 Mittal it was found 46.6% which were statistical- P et al (64% and 36%) respectively.14,15 There was ly significant. The author correlated abnormal trac- no significant correlation of fetal heart rate patterns, ings with neonatal mortality and morbidity and neonatal and intraoperative findings with maternal concluded that electronic fetal monitoring reduces age, parity and fetal weight. hypoxia related death of neonate by 60%. Their Meconium stained liquor was 35.2%, variable De- correlation with oligohydramnios and abnormal celeration was 37% in our study which is very much CTG findings were 67.9% and in Mittal study more than the study done by Bhartiya et al16 whose 32.2% whereas Nuchal cord 14.13% and 41.1% all result was 1% and 2% and Rana et al15 whose result were statistically significant.
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