Cardiotocography Findings Research Articles

THE ROLE OF CARDIOTOCOGRAPHY IN ASSESSING THE CONDITION OF A FETUS IN PREECLAMPSIA

The role of cardiotocography (CTG) in preeclampsia is still vaguely defined. The aim of this study was to investigate the possible role of CTG in assessing the condition of the fetus in preeclampsia with and without intrauterine growth retardation (IUGR) and to compare the CTG findings with Doppler parameters and perinatal outcome. The prospective study included 30 singleton pregnancies with preeclampsia completed by caesarean section. The study group was divided into subgroups based on the presence of IUGR in relation to the severity of preeclampsia. The control group consisted of 20 healthy women delivered by elective caesarean section. In 53.3% of preeclamptic cases, cardiotocographic findings differed from normal (p<0.001) and they were either warning or pathological. There were no significant differences in the presence of a pattern deviating from normal based on the severity of preeclampsia, and it was significantly more prevalent in preeclampsia with IUGR (p<0.01) than the one without it. The prevalence of CTG pattern types in the study group was significantly altered by presence of olygoamnion (p<0.05) as well as the parameters of the flow through the uterine arteries, umbilical artery and middle cerebral artery (p<0.05). Apgar score significantly depends on the CTG findings and decreases with the unfavourable CTG pattern. CTG and Doppler ultrasonography complement each other in order to improve perinatal outcome in preeclampsia. CTG is irreplaceable as a first measure of rapid assessment of the fetal condition in newly diagnosed cases of preeclampsia, aiming also to and in order to detect complications from umbilical cord during its follow-up.

Antepartum and intrapartum cardiotocography and fetal outcome in high-risk pregnancy

The objective of the study was to find out the incidence of abnormal cardiotocography (CTG) findings in pregnancies at risk, to find out the suitable time of delivery of the fetus at risk and to find out the fetal outcome in abnormal antepartum CTG findings. It is a prospective study where 450 highrisk pregnancy cases of different gestational age, ranging from 32-42 weeks were selected from BSMMU, Dhaka and Khalishpur Clinic, Khulna from 2003 to 2013. CTG was done on admission and the subjects were followed-up till delivery. The data obtained from the present study were compiled and appropriate statistical analysis was carried out using SPSS. Out of the cases, normal CTG was found in 357 cases and abnormal CTG was found in 93 cases. Among these 93 cases, normal outcome was found in 87 cases (93.1%) and abnormal outcome in 6 cases (6.9%). The specificity, sensitivity, negative predictive value and positive predictive value for antepartum CTG was 92.5%, 20.5%, 81.9% and 49.3%, respectively. This study revealed that CTG shows more accuracy in case of healthy fetus that a normal CTG almost always gave a normal fetal outcome. But if CTG showed abnormality, the fetal outcome may be normal. So a more accurate correlation with other biophysical and biochemical parameters of fetus is to be done for further evaluation. DOI: http://dx.doi.org/10.3329/mediscope.v1i1.21632 Mediscope Vol. 1, No. 1: 2014, Pages 19-22

Cardiotocography in the prognosis of perinatal outcome.

ABSTRACTAim:The objective of the study was to examine whether cardiotocography can (CTG) predict asphyxia of the embryo, manifested as hypoxic-ischemic encephalopathy (HIE), and to what extent one can rely on CTG record.Material and methods:Retrospective research was carried out at the Clinic for Gynecology and Obstetrics UKC Tuzla and medical documentation from the history of mothers and newborns was used. The study group consisted of 68 pregnancies and newborns who developed HIE. The control group consisted of 40 pregnancies, which resulted in birth of healthy newborns – without signs of asphyxia. CTG records were analyzed, Apgar score, the ways of finishing delivery.Results:Pathological CTG records (bradycardia 100, tachycardia 180, silent type of curve, late decelerations) were found in 45 (66,17%) cases of the study group in comparison to 11 (27,5%) in the control group. In the study group Apgar score in 5th minute lower than 7 had 17,46% newborns and the highest incidence of the normally finished deliveries. We conclude that cardiotocography is one of the reliable methods of fetal monitoring in pregnancy and delivery, and that pathological CTG record very likely indicates the possible presence of perinatal asphyxia.Conclusion:Achieving a low degree of correlation between pathological intrapartum cardiotocography findings and long-term outcome of children can be achieved by rapid and adequate obstetric intervention and the relatively short duration of fetal acidosis, and optimal procedures during intensive care of newborns.

Study of efficacy, safety and cardiotocographic changes during epidural analgesia with ropivacaine in labour

Background: Epidural analgesia during labour provides effective pain relief along with better maternal and neonatal outcome. Our aim of the study is to check safety and efficacy of Ropivacaine during labour analgesia. We have also compared cardiotocographic changes in labour with versus without epidural analgesia. Material & Methods: 60 Antenatal cases in between 37-41 weeks of pregnancy in active labour were selected for study. They were randomly divided into 2 groups: Study Group (Group-1): Patients who received epidural ropivacaine for pain relief. Control Group (Group-2): No analgesia was given for pain relief. Epidural catheter was inserted in study group. They were observed for degree of pain relief, requirement of analgesia, intrapartum cardiotocographic changes and maternal tolerability and safety in terms of side effects. They were also asked for their satisfaction towards epidural analgesia. Observation & Results: We have observed better intrapartum cardiotocographic findings with epidural analgesia. Degree of pain relief was also significantly better with epidural group. Requirement of Top-up doses and duration of rescue analgesia was better with epidural. No significant maternal or fetal side effects were noted with epidural. Patient satisfaction was definitely better with Epidural analgesia. Conclusion: Ropivacaine in epidural is safe and effective and efficacious with better cardiotocographic findings.

Role of kleihauer test in detection of fetomaternal haemorrhage (FMH) in women with reduced fetal movements

Massive Fetomaternal haemorrhage (FMH) of more than 30 ml can cause significant fetal morbidity and mortality. Reduced fetal movements can be the only presenting symptom.There is no consensus among obstetricians...

Patrones de frecuencia cardíaca fetal y su relación con la saturación de oxígeno del feto

Foetal pulse oximetry can distinguish between normal patterns of cardiotocographic findings and patterns compatible with foetal acidosis, but are not useful in identifying patterns that indicate atypical changes or stress. Objective To evaluate the usefulness of intrapartum foetal pulse oximetry in distinguishing between foetal heart rate patterns defined according to functional criteria. Subjects and methods A total of 534 pregnant women were monitored with cardiotocography and foetal pulse oximetry during dilation. Heart rate tracings were classified according to a model based on clinical response. Results FSpO2 values in foetuses with normal heart rate tracings were higher than in the other 4 groups (p<0.05). Tracings compatible with acidosis were associated with lower oxygen levels than normal tracings, atypical tracings and tracings indicative of stress (p<0.05). There were no significant differences between the other groups. Conclusions Use of foetal oxygenation findings to reach a prognosis regarding functional classification was useful only when interpretation of the heart rate tracings was straightforward, and was of limited use when the tracings did not clearly reflect either a normal or clearly pathological status.

Doppler flow velocity to measure the redistribution of fetal cardiac output in fetal stress

The pathophysiologic continuum of poor uterine and placental blood flow associated with fetal growth restriction has to be considered the major cause of poor birth outcomes. The main attention in this context is drawn to the possibilities of an early diagnosis of imminent fetal compromise prior to and under delivery. With regard to this, the detection of a reduced fetal oxygen saturation (fetal stress) plays a crucial role, whereat an acute incident causing fetal hypoxemia has to be differentiated from a chronic hypoxemic condition. An acute hypoxemia under delivery is best detected by cardiotocography. Due to its infrequent and unpredictible occurrence, an acute antenatal hypoxemia usually escapes common surveillance methods. Fetal biometry and pulsed Doppler sonography are to be considered the most suitable methods to diagnose chronic hypoxemic fetal conditions. The interrogation of a combination of peripheral and central vessels allow the sonologist to characterize the extend of a progressivly deteriorating oxygen supply. However, this correlation is not yet completely understood. Therefore, clinical consequences still have to be drawn by cardiotocographic findings indicating a global cardiac decompensation.

Umbilical cord blood gas analysis in augmented labour

Labour augmentation with oxytocin may produce an excessive increase in frequency, duration or strength in uterine contractions which may result in fetal stress. Umbilical cord acid-base assessment provides an objective parameter in evaluating the neonatal condition immediately after delivery. We evaluated the neonatal condition in 235 deliveries where oxytocin was used for labour augmentation. The umbilical cord blood acid-base status was correlated with intrapartum cardiotocographic findings and Apgar scores. In two cases we noted umbilical artery pH <7.05 but the BDecF was not higher than 11 mmol/l and the 5-minute Apgar score was 8 in all cases. Our results indicate that the use of oxytocin for labour augmentation had no adverse effects on neonatal condition.

Clinical features of and cardiotocographic findings for premature infants with antenatal periventricular leukomalacia.

To clarify the clinical features of and cardiotocographic findings for premature infants with antenatal periventricular leukomalacia (PVL). Antenatal PVL was judged to be present if a cyst greater than 3 mm in largest diameter was detected in the periventricular region by the 14th day of life on cranial ultrasonography. The clinical features of and cardiotocographic findings for 12 premature infants with antenatal PVL born within 1 year were compared with those of 12 infants chosen as control group matched in gestational age at birth from the premature infants without antenatal PVL born within the study period. Abnormalities of the umbilical cord such as coiling, excessive torsion and membrane insertion were observed more frequently for infants with antenatal PVL (58.3%) than for control infants (16.7%) (P<0.05). Frequent moderate variable deceleration on the fetal cardiogram was also observed more frequently for infants with antenatal PVL (80.0%) than for control infants (27.3%) (P<0.05). Abnormalities of the umbilical cord and frequent moderate variable deceleration on fetal cardiotocogram appear to be causes of antenatal PVL in premature infants.

Prediction of perinatal outcome by middle cerebral artery Doppler velocimetry.

The relationship between pulsatility index (PI) in the middle cerebral artery (MCA) and adverse perinatal outcome was studied in 162 normal and 75 high-risk pregnancies. The intrapartum cardiotocographic (CTG) findings, the mode of delivery, 1 and 5-minute Apgar scores, the pH level of the umbilical artery, admission to the neonatal intensive care unit (NICU) and the incidence of intrauterine fetal growth retardation were recorded. In the low risk group, the PI values in the MCA were only affected in growth retarded fetuses (P = 0.0084). In the high-risk group, there was an association between the MCA PI values and 5-minute Apgar scores (P = 0.0397), umbilical artery pH values (P = 0.0068) and development of IUGR (P = 0.0376). In both groups, an abnormal intrapartum CTG, the 1-minute Apgar score, cesarean section for fetal distress and admission to the NICU were not related to PI values in the MCA. Our present study suggests that Doppler flow measurement of MCA provides useful information about perinatal outcome, especially in the high-risk pregnancies.

Vorzeitige Plazentalösung - Klinische Befunde und fetale Überwachungsmethoden

In a study group of 41 pregnant women of postpartally confirmed placental abruption, the prognostic value of clinical and diagnostic findings was investigated. The incidence of placental abruption was 1.4% of all deliveries within a three-year interval. 51% of patients showed vaginal bleeding before delivery. Retroplacental haematoma was found in 49% of cases ultrasonographically. A total of 75% had a pathological CTG test. More than 95% of these findings occurred within 3 days before delivery. Abnormal Doppler flow findings in foetal vessels more than 3 days before delivery were seen in 62% of cases. In the last three days before delivery, 86% were abnormal. Preterm delivery before 37 weeks of gestation was registered in 82% of patients. Perinatal mortality amounted to 12%. The rate of severely dystrophic newborn was 30%. Even in cases with lack of the clinical and/or sonographical findings, the possibility of placental abruption should be considered, if an acute deterioration of cardiotocographic or Doppler-sonographic findings.

Comparison of umbilical arterial versus umbilical venous blood PH correlated with arterio-venous glucose difference and cardiotocographic score

The value of clinical parameters and umbilical arterial blood pH as indicator of prenatal hypoxia is disputed. In a prospective study of 86 vaginally delivered full-term infants, cardiotocographic (CTG) findings obtained 0-30 min and 30-60 min before birth were compared to pH values, O2 and CO2 partial pressures and glucose difference in umbilical arterial and venous blood. CTG findings were expressed as a score, higher values indicating fetal hypoxia. The venous but not the arterial blood pH was significantly related to the later (0-30 min) CTG score. The arterio-venous glucose difference was significantly related to both CTG scores. There was a significant statistical relationship between glucose difference and venous but not arterial blood pH. The later CTG score (0-30 min) also correlated significantly with O2 and CO2 partial pressures and base excess in the umbilical vein of all vaginally born infants. If CTG is accepted as an objective indicator of fetal hypoxia before birth, the arterio-venous glucose difference, and in the investigated range of pH-values, umbilical venous blood pH are more suitable than the arterial blood pH to ascertain the peripartal situation of the newborn.

Reversal of fetal distress by emergency in utero decompression of hydrothorax

OBJECTIVE: The purpose of our study was to determine whether in utero pleural decompression can improve abnormal cardiotocograms resulting from compressive fetal hydrothorax. STUDY DESIGN: We reviewed all cases of fetal hydrothorax referred to our level 3 fetal medicine unit. Highly pathologic cardiotocographic findings were observed in four third-trimester patients. All had mediastinal compression that resulted in skin edema on the upper part of the body. Prenatal therapy was performed on an emergency basis, two with thoracocentesis and two with pleuroamniotic catheters. RESULTS: One patient went into intractable bradycardia on arrival in the department and died in spite of immediate thoracocentesis. The other three recovered, with normal heart rate patterns after pleural decompression. CONCLUSION: Emergency prenatal therapy may reverse fetal distress in utero, allowing time for delivery of uncompromised infants if possible after a complete evaluation of nonimmune hydrops.

Der Einfluß von Schwangerschafts- und perinatologischen Parametern - einschließlich Entbindungsmodus - auf die Überlebensrate „kleiner Frühgeborener“ (&lt; 1500 g)

A retrospective analysis of 225 very low birth weight infants (less than 1500 g) was made, to assess the influence of the mode of delivery on the survival rate. In 186 preterm deliveries which could not be prevented by therapeutic measures, we included additionally certain gestational and perinatological parameters. Generally, an average survival rate of 72% was found in this study. In addition to the well-known negative influence of birth weight less than 1000 g and gestational age of less than 28 weeks, such parameters as antenatal pre-pathological CTG findings, haemorrhages at the time of hospitalisation, and ineffectuousness of tocolytic drugs, were associated with a reduced survival rate. In contrast, the presence of anamnestic risk factors of preterm delivery and prolongation of gestation by one day and more improved the survival rate. Additional consideration of foetal presentation showed, that abdominal delivery was fundamentally safer in cases with breech and transverse presentation. Whether a higher survival rate can be achieved by vaginal delivery in cases of breech presentation with premature rupture of membranes or a gestational age greater or equal to 28 weeks, remains to be proved. A gestational age of less than 28 weeks or antenatal prepathological cardiotocographic findings will facilitate in future the decision to perform Cesarean section in cases of inevitable premature deliveries with cephalic presentation.

Changes in vascular resistance in the umbilical and middle cerebral arteries in the human intrauterine growth-retarded fetus, measured with pulsed Doppler ultrasound

To assess how different cardiotocographic (CTG) findings are related to changes in vascular resistance, 256 normal and 37 growth retarded (IUGR) fetuses from 27 to 41 weeks of gestation were studied. Immediately following CTG monitoring, pulsed Doppler was used to identify flow velocity waveforms in both the middle cerebral artery (MCA) and the umbilical artery (UA), and from these the Resistance Indices (RIs) in both arteries (RI MCA and RI UA) were calculated. Of the 37 growth retarded fetuses, 25 had normal CTG findings. Although only 3 (12.0%) of these fetuses had low RI MCA, 12 (48.0%) had high RI UA, statistically different ( P< 0.01) from normal fetuses. In 11 of 12 (91.7%) growth retarded fetuses with an abnormal CTG, there were low RI MCA values, significantly more ( P< 0.01) than in those with a normal CTG. As for RI UA, all 12 IUGR fetuses with an abnormal CTG had high RI UA values (100%), a much higher proportion ( P < 0.01) than was found in the normal CTG group. These results mean that intrauterine fetal growth retardation per se is associated with a chronic increase in the RI value in the umbilical artery. By contrast, cerebral vascular resistance appears to decrease in compromised conditions, as indicated by abnormal CTG findings.

Obstetrical characteristics of a loss of end-diastolic velocities in the fetal aorta and/or umbilical artery using Doppler ultrasound.

In 30 of 137 high-risk pregnancies we observed absent end-diastolic velocities indicating a high downstream impedance, which could be proved by histomorphological findings of the placenta. On the average the loss of end-diastolic velocities occurred 2-3 days before suspicious and nearly 8 days before pathological cardiotocographic findings. The perinatal mortality was high when absent velocities had been observed before the 32nd week, a cesarean section was obligatory in all but 1 case. All fetuses were growth-retarded. In 9 cases we were able to determine the ratio of blood flow volume in the common carotid arteries to that of the fetal aorta. The values were significantly increased as compared to values of undisturbed pregnancies, demonstrating a redistribution of fetal blood in favor of cerebral circulation.

Die kindliche Frühmorbidität und die Spätentwicklung nach primärer abdominaler Schnittentbindung bei Beckenendlage in Terminnähe

This study concerns the results obtained in respect of early morbidity and late development of 115 and 57 children, respectively, born between 1978 and 1983, who had been delivered by primary low cervical Caesarean section shortly before term. Early morbidity of the 115 children was analysed taking into consideration the risk factors, such as premature rupture, gestation diabetes, EPH gestosis, condition following Caesarean section, abnormal amnioscopic and antepartal cardiotocographic findings, as well as the methods of anaesthesia employed. In the study on late development 57 children between 1 1/4 and 6 years of age were followed up and examined with regard to several faculties (social contact, fine motoricity and adaptation, speech and gross motoricity) according to the Denver Developmental Screening Test. Children with abnormal findings were subjected to special examination. Children with abnormal findings were also subjected to a positional test according to Vojta and to the Munich functional developmental diagnosis after Hellbrüge et al. While employing physiotherapy after Bobath and early rehabilitation training by the parents, these children were followed up at regular intervals. There was no clinically relevant acidosis in the group of 115 newborn. A total of 44 newborn (38%) displayed slight to medium enhanced acidity (pH value, umbilical artery: 7.20 to 7.29) according to the stage classification after Saling and Wulf. Slight to medium acidosis (umbilical artery pH 7.10 to 7.19) was seen in 3 cases only (2.6%). In 112 newborn we found a correlation between the good Apgar score values (7-10) and normal acidity in the umbilical artery blood (act. umbilical artery pH greater than or equal to 7.30). In the remaining 3 newborn with lower Apgar scores (3-6) there was no acidosis in the umbilical artery blood. In the follow-up group (57 cases) we found one child with psychomotor retardation of speech (disturbed articulation and reduced vocabulary) and 6 children with slight motor disturbances in the early developmental stage. These disturbances were recorded as slight central disturbances of coordination according to Vojta within the framework of early diagnosis. Four of these children received early treatment according to Bobath. When they were between 1 and 1 1/2 years of age, all the 4 children showed normalisation of motoricity during the follow-up checks. The other two children displayed spontaneous regression of the mild central disturbance of coordination when they were 5 and 6 months of age.(ABSTRACT TRUNCATED AT 400 WORDS)

Elective fetal monitoring and obstetrical operative frequency

This paper reports on cardiotocographic findings after the introduction of elective fetal monitoring. A classification into the following four groups is recommended: normal, warning, severe functional hemodynamic disorders (SFHD) and hypoxia. This fetal heart frequency (FHF) classification prefers the evaluation of the effects on fetal condition compared with a descriptive classification. SFHD in the first stage of labor can be observed in 4% of parturient women, increasing to nearly 16% in the second stage. Cesarean section rate in this group amounts to 12.5% and forceps rate exceeds 50%. Under the condition of elective fetal monitoring (94% in total) and a reserved application of cesarean section (4.3% in total) and generous forceps delivery (15% in total) a perinatal mortality rate of 13‰ for obstetrical material with high-risk concentration is achieved. The total acidosis rate (pH < 7.20) decreases to 2.3%, whereas the rate of severe acidosis (pH < 7.10) was observed in only 0.4% of the cases. With elective fetal monitoring a low cesarean section rate taking critical evaluation into consideration and using all conservative methods of treatment is obtained. By means of the generous application of the single or repeated bolus injection of 25 μg fenoterol and the operative shortening of the second stage of labor in the case of SFHD, the neonatal morbidity can be kept at a low level. The small number of fetal or maternal complications using the direct methods of fetal supervision and the careful operative termination of labor justifies the recommended obstetrical management.