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Analysis of Cardiotocography Findings in Pregnancy with Less Fetal Movement and Its Association with Perinatal Outcome Salma U1, Jabeen M2, Shimul S3, Akhter D4

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Analysis of Cardiotocography Findings in Pregnancy with Less Fetal Movement and Its Association with Perinatal Outcome Salma U1, Jabeen M2, Shimul S3, Akhter D4 Original Article Analysis of Cardiotocography Findings in Pregnancy with Less Fetal Movement and Its Association with Perinatal Outcome Salma U1, Jabeen M2, Shimul S3, Akhter D4 Abstract on CTG than reassuring [3(6.1%)] on CTG (p>0.05). Twenty six (51.0%) neonatal of the non-reassuring were Less fetal movement affects perinatal outcome. To admitted into neonatal unit whereas only 9 (18.4%) examine association between antenatal CTG findings neonatal of the reassuring were admitted into neonatal and perinatal outcome in women with less fetal unit. It can be concluded that CTG may be the first line movement. This prospective observational study was investigation for ante and intrapartum fetal assessment. conducted in the department of Obstetrics and Gynecology, Kumudini Women's Medical College and Keywords: CTG, Less Fetal Movement, Perinatal Hospital, Mirzapur, Tangail over a period of six months Outcome. from January 2015 to June 2015. It included 100 pregnant women after 34 weeks of gestation. They Number of Tables: 05 underwent a cardiotocogram (CTG) test. Data were Number of References: 19 collected by face-to-face interview, observation and document review. The mean age of the women was Number of Correspondences: 04 24.37±4.62 (SD) years and mean gestational age was Introduction 38.48±2.15 weeks. In this study, 82.0% of the cases presented at term pregnancy, 42.0% of the women were A reduction of fetal movements causes concern and primi gravida and rest falls between 2nd to 4th gravida. anxiety, both for the mother and obstetrician. Reduced Normal vaginal delivery was in 59.0% cases and rest fetal movement is difficult to interpret because it is a were undergone caesarean sections (41.0%). Late subjective complaint by the mother1. Decreased fetal deceleration with decreased variability was (23.5%) movement affects 5 - 15% of pregnancies2. most common. Incidence of low birth weight was 16.0% Currently there is no universally agreed definition of & macrosomia was 5.0%. Birth asphyxia was found in DFM. In a study of women with normal uncomplicated 52.0% cases, 49.0% needed immediate resuscitation, pregnancies, 99% of women were able to feel 10 35.0% were admitted into neonatal unit and early movements within 60 minutes3. Studies have been neonatal death was 8.0%. Birth asphyxia was conducted on the correlation between maternal perception significantly higher in non-reassuring [37(72.5%)] than of fetal movements and fetal movements detected on reassuring [15(30.6%)] on CTG. Incidence of low birth ultrasound scans, showing large variations, with weight was higher in non-reassuring [11(21.6%)] than in correlation rates ranging from 16-90%4,5. This variation in reassuring [5(10.2%)] on CTG (p>0.05). Early neonatal maternal perception may be related to gestational age, death was more in respondents with non-reassuring [5(9.8%)] amount of amniotic fluid volume, medications, fetal sleep 1. Corresponding Author: state, obesity, anterior placenta, smoking and Dr. Ummay Salma nulliparity6,7. Assistant Professor Department of Obs & Gynae Maternal perception of DFM is a common cause of 8 Kumudini Women's Medical College and Hospital, Tangail. unplanned antenatal presentation in the third trimester . e-mail: [email protected] Maternal perception of DFM is associated with increased 2. Dr. Mahe Jabeen incidence of a number of adverse pregnancy outcomes Associate Professor including stillbirth, preterm delivery and intrauterine 9 Department of Obs & Gynae growth restriction . Recent evidence suggests that the ICMH, Matuail, Dhaka-1362 improved management of DFM and uniform information 10 3. Dr. Sabiha Shimul to women may be associated with fewer stillbirths . Registrar Cardiotocography (CTG) is the graphical presentation of Department of Obs & Gynae fetal heart activity and the uterine contraction to detect the US Bangla Medical College & Hospital, Rupshi, Tarabo, Narayangonj. fetal hypoxia1. It is the most commonly used test for 4. Dr. Dilruba Akhter antepartum and intrapartum fetal surveillance in the Professor majority hospitals of developed countries11. This Department of Obs & Gynae technology was first developed in 1950 and became ICMH, Matuail, Dhaka-1362 commercially available in 196011. The goal of antepartum 2018 Volume 30 Number 01 Received: 08 May 2017 Accepted: 30 November 2017 19 ORIGINAL ARTICLE fetal surveillance is to predict, diagnose and timely Table-II: Obstetric characteristics of study population intervene the pregnancies those are complicated with fetal (n=100). asphyxia and might lead to fetal and newborn morbidity Characteristics Frequency (n) Percentage (%) and death12. Cardiotocography (CTG) is also termed as Gestational age (weeks) electronic fetal monitoring. A predictive fetal heart rate Term ( 37 to 42 weeks) 82 82.0 Preterm (28 to < 37 weeks) 15 15.0 record is the principle indication that led to intervention Post-Term (> 42 weeks) 3 3.0 and delivery. A prediction of fetal asphyxia that leads to Mean±SD 38.48±2.15 (34 - 44) intervention and delivery may prevent or modify (min-max) 42.0 Gravida Status 33.0 moderate or severe newborn morbidity as the result of Primi 42 17.0 fetal asphyxia13. 2nd 33 8.0 3rd 17 The fetus' health is evaluated by assessment of the fetal 4th 8 59.0 heart rate (FHR). This assessment involves identification Mode of delivery 41.0 Normal virginal delivery 59 of two general types of FHR patterns: those that may be Caesarean Section 41 20.0 associated with adverse fetal or neonatal outcomes (ie, Premature rupture of membrane non-reassuring patterns) and those that are indicative of 24 hours 8 10.00 fetal well-being. But there is no evidence from < 24 hours 12 4.00 Preeclampsia 10 randomized trials that proves antepartum FHR monitoring Diabetes Mellitus 4 results in a decreased risk of fetal death14. n: Number of subject Materials and Methods According to CTG findings 49.0% cases were reassuring and 51.0% were non-reassuring. Absent or decreased This hospital based prospective observational study was variability was 8 (8.0%), fetal bradycardia was 7 (7.0%), conducted in the Department of Obst. & Gynae, fetal tachycardia was 6 (6.0%), variable deceleration with Kumudini Women's Medical College and Hospital, fetal bradycardia was 5 (5.0%), variable deceleration was Mirzapur, Tangail from January 2015 to June 2015 for a 7 (7.0%), late deceleration with decreased variability was period of six months. A total of 100 pregnant women with 12 (12.0%), and late deceleration was 6 (6.0%) (Table III). less fetal movement were included as study population. Purposive sampling technique was adopted. Pregnant Table-III: Distribution of study population by CTG women with multiple pregnancy, eclamptia or severe findings (n=100). preeclampiac, lethal congenital abnormality, severe Cardiotocography findings Frequency (n) Percentage (%) Reassuring 49 49.0 oligohydramnios and GA<34 weeks were excluded from Non-reassuring 51 51.0 the study. Written consent was taken from each study Late deceleration 6 6.0 population before interview. All of the study subjects Late deceleration 12 12.0 with decreased variablity underwent a cardiotocogram (CTG) test. Data were Variable deceleration 7 7.0 collected by face-to-face interview, observation and Variable deceleration with 5 5.0 document review. fetal bradycardia Fetal tachycardia 6 6.0 Results Fetal bradycardia 7 7.0 Absent of decreased variability 8 8.0 Sixty six percent of the study population was in the age n: Number of subject group 20 - 29 years and 20% had an age above 30 years. In this study incidence of low birth weight was 16.0 % & The mean age was 24.37±4.62 (SD) years (Table I). macrosomia was 5.0%. Birth asphyxia was found in 52.0% cases, 49.0% needed immediate resuscitation, Table-I: Age distribution of the study population (n=100). thirty 35.0% were admitted into neonatal unit and early Age (years) Frequency (n) Percentage (%) neonatal death was 8.0%(Table IV). <20 14 14.0 20 to 30 66 66.0 Table-IV: Perinatal outcome in study population (n=100). 30 and above 20 20.0 Perinatal outcome Frequency (n) Percentage (%) Mean±SD (min-max) 24.37±4.62 (18-35) Birth Weight Normal ( 2.5 to <4 kg ) 79 79.0 n: Number of subject Low birth weight (<2.5 kg) 16 16.0 Mean gestational age of the study population was Macrosomia ( 4 kg) 5 5.0 38.48±2.15 weeks. Present study found 82.0% of the Birth asphyxia 52 52.0 Needed resuscitation 49 49.0 cases term pregnancy, 42.0% were primi gravida and Needed admission to neonatal unit 35 35.0 58.0% falls between 2nd to 4th gravida. Regarding mode Early Neonatal Death 8 8.0 of delivery, 59.0% delivered by normal vaginal delivery n: Number of subject and rest were undergone caesarean sections (41.0%) Birth asphyxia was significantly higher in non-reassuring (Table II). [37(72.5%)] than that of reassuring [15(30.6%)] on CTG. 20 2018 Volume 30 Number 01 ORIGINAL ARTICLE Incidence of low birth weight was higher in non- absent beat-to-beat variability. Present study showed that reassuring [11(21.6%)] than in reassuring [5(10.2%)] on early neonatal death was more in nonreassuring CTG CTG but the difference was not statistically significant than reassuring CTG. Five early neonatal death was (p>0.05). Early neonatal death was more in respondents noted in nonreassuring CTG. Birth Asphyxia was found with non-reassuring [5(9.8%)] on CTG than reassuring in 52.0% of the cases. Immediate resuscitation was [3(6.1%)] on CTG but the difference was not statistically needed 49.0% cases. Thirty five percent babies need significant (p>0.05). Twenty six (51.0%) neonatal of the admission in neonatal unit and early neonatal death was non-reassuring were admitted into neonatal unit whereas 8.0%.
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