Abnormal Cardiotocography Research Articles

Antepartum cardiotocography--an audit.

Between 1981 and 1986, 9,840 women were monitored by antepartum nonstressed cardiotocography (CTG). A satisfactory fetal reserve pattern was detected in 91%, a reduced reserve pattern in 8% and a critical reserve pattern in 1%. The incidences of fetal growth retardation, Apgar score less than 6 at 1 minute, perinatal mortality and Caesarean section all increased significantly (p less than 0.001) as the degree of cardiotocographic fetal reserve worsened. Intrauterine growth retardation and/or low urinary oestriol excretion was associated with a highly significantly increased incidence of abnormal CTG traces (14.2%, p less than 0.001). A satisfactory fetal reserve pattern on cardiotocography was a reliable predictor of fetal well-being, since after exclusion of lethal malformations, the perinatal mortality rate in those patients monitored within 7 days of delivery was 3/1,000.

The relation between the need for intubation at birth, abnormal cardiotocograms in labour and cord artery blood gas and pH values.

A consecutive series of 56 infants of 32 weeks gestation or more who were resuscitated at birth by endotracheal intubation was studied to determine the occurrence of abnormal cardiotocograph traces and acidosis as determined by cord artery blood measurements. Thirty-two infants (57%) had neither cardiotocographic abnormalities nor acidosis; in this group the factors associated with the need for intubation were meconium stained amniotic fluid, operative delivery, anaesthetic agents given to the mother, a tight nuchal cord, and traumatic vaginal delivery. The need for intubation at birth should not automatically be regarded as evidence of intrapartum hypoxia or disturbed acid-base balance.

The Significance of Cardiotocographic Monitoring in Pregnancy Complicated by Intrauterine Growth Retardation and Prematurity

Intrauterine growth retardation is a condition of chronic fetal compromise. The most accurate method of fetal assessment in this condition is by serial cardiotocography. In pregnancy associated with intrauterine growth retardation, abnormal cardiotocography with spontaneous decelerations may be an indicator of imminent fetal death in utero. Delivery should be effected immediately if the fetus is at a gestation where viability is probable.

Risk factors and perinatal problems in small for gestational age pregnancies.

Risk factors and perinatal problems in 100 consecutive pregnancies resulting in an infant below the 5th centile weight (study group) were compared to those seen in 100 infants of birth weights between the 10th and 90th centile. Eleven risk factors found to be more common in the study group were used to form a risk score. A score of four or more was found in 12% of controls, in 44% of the study group and 78.4% of the study group in which complications occurred. There was one antepartum death and one case of meconium aspiration in the study group. Abnormal cardiotocograph tracings, operative deliveries, and poor feeding were significantly higher in the study group. All infants were of at least 36 weeks gestation.

Nonstressed antepartum cardiotocography in patients undergoing elective cesarean section—Fetal outcome

In a prospective study of 409 patients monitored with nonstressed antepartum cardiotocography and delivered by elective cesarean section, cardiotocography was requested for 170 because of clinical indications. This group had higher incidences of abnormal cardiotocography (p < 0.001), fetal growth retardation (p < 0.001) and neonatal deaths (p < 0.025) than had the group without such requests, suggesting that clinicians effectively selected the high-risk pregnancy for testing of fetal well-being. Cardiotocographic evidence of critical reserve was found in 17 of 170 patients (10%) tested for a clinical indication and in none of the 239 patients in the control group. Patients with abnormal cardiotocography results had significantly higher incidences of cord arterial blood pH < 7.26 (p < 0.05) and Apgar scores of <6 at 1 minute (p < 0.001), showing that an abnormal cardiotocogram is indicative of a fetus at risk of having hypoxia.

Fetal activity in pregnancies complicated by maternal diabetes mellitus.

SummaryThe incidence of fetal breathing movements (FBM), fetal trunk movements (FTM), and total fetal activity (TFA) was assessed in 25 pregnancies complicated by maternal diabetes mellitus; 20 mothers had been juvenile insulin dependent diabetics, 4 were diagnosed during pregnancy (one of whom required insulin) and there was one other who was changed from chlorpropamide to insulin during the first trimester of pregnancy. Thirty‐minute records were made postprandial between 32 and 38 weeks making a total of 161 recordings. There were 15 well‐controlled insulin‐dependent diabetic women with uncomplicated pregnancies; and in this group the mean percentage incidence of FBM was 60±25 (SD) per cent, FTM 16±10 (SD) per cent and TFA 73±22 (SD) per cent. The mean breathing rate per minute was 53±12 and the mean number of movements per 30‐minute period 29±18. The incidences of FBM and TFA were significantly higher than those found in postprandial recordings in normal pregnancies. There was only one recording out of 115 where the incidence of TFA fell below 10 per cent. The mean percentage incidences of FBM, FTM and TFA were similar in the four uncomplicated pregnancies in which diabetes was diagnosed during pregnancy. The mean percentage incidence of TFA was significantly lower in the six pregnancies with obstetric complications, and levels of TFA below 10 per cent correlated well with abnormal cardiotocograph traces or fetal distress in labour.