CTG Changes Research Articles

A Study to Determine the Perinatal Outcome in Isolated Oligohydramnios at Term Pregnancy

Objective: A Study to Determine the Perinatal Outcome in Isolated Oligohydramnios at Term Pregnancy Study Design: A cross-sectional study Place and Duration: Department of Gynecology and Obstetrics, Hayatabad Medical Complex from October 2022 to March 2023 Methodology: Our sample size was 250 which were divided into 1:1 including 125 cases with isolated oligohydramnios and 125 control cases. Patients with chronic medical disorders and having fetal anomalies or IUGR were excluded. The mode of delivery was noted. Neonatal outcomes in the form of Apgar score, baby weight and need for NICU were noted. Results: The cases with isolated oligohydramnios were associated with an increased incidence of CTG changes, meconium-stained amniotic fluid and the cesarean section as compared to women with normal amount of amniotic fluid. There was no difference between the cases and controls as regards duration of labor, need for oxytocin augmentation, need for neonatal resuscitation, APGAR score at 5 minutes, NICU admission birth weight of neonates or incidence of LSCS for fetal distress. A significant association (OR=1.85, P<0.001) was found between caesarean section in mothers with oligohydramnios compared to controls. Conclusion: Our study found increase cesarean section rate due to CTG changes and meconium stained liquor in isolated oligohydramnios. However neonatal outcome in the form of birth weight, Apgar score and NICU admission was same for both cases and control. Keywords: Oligohydramnios, Perinatal, Term Pregnancy

Perinatal Outcome in Meconium Stained Amniotic Fluidat Dhiraj General Hospital, a Tertiary Health Care Centre in Rural Gujarat: A Prospective Study

Introduction: Meconium in amniotic fluid is a serious sign of fetal compromise and associated with a perinatal complications and outcome, including low APGAR scores, increased incidence of chorioamnionitis, increased incidence of neonatal intensive care admission and high rate of perinatal death. It is less likely for a fetus to pass meconium before 34 weeks of gestation. After 37 weeks its incidence increases steadily with increasing gestational age. It reflects maturation of fetal myelination and parasympathetic innervations. Aspiration can occur in utero with fetal gasping or with the first breath of life after birth. However most of the infants with meconium in liquor do not have low APGAR score, acidosis or clinical illness compared to the infants born with clear amniotic fluid. Material and method: A prospective observational study was conducted in obstetrics and gynaecology department of Dhiraj Hospital, Sumandeep Vidyapeeth from March 2019 to August 2020. Methodology: After history and clinical examination,all patients were allowed to go in labour and were watched throughout labour. • Patients who had meconium stained liquor on spontaneous or artificial rupture of membrane were taken as cases. • Other patients who did not have meconium stained liquor throughout labour were taken as controls. • Time of meconium passage, consistency of meconium was noted in each case. • Thin meconium and thick meconium cases were seperately identified. • Fetal heart rate patterns were monitored throughout labour. • Type of delivery whether spontaneous, oper-ative vaginal or LSCS was noted in each case. • APGAR scoring at 1 and 5 minutes, need for resuscitation, stomach wash and endotracheal intubation in baby was noted. • Need for NICU admission for complications like respiratory distress syndrome, aspiration pneumonia, birth asphyxia, septicemia, jaundice, convulsion, hypoxic ischemic encephalopathy was noted. • Duration of hospital stay of neonate was noted. Statisical method: As this was a prevalence study, purposive sampling was done. All the categorial variables were analysed with the help of chi square test and fisher’s exact test and all the continuous variables were analysed with independent ‘t test’. Conclusion: Thus to conclude Thick MSL is associated with abnormal CTG changes, higher incidence of LSCS, low apgar score and more NICU admissions due to Meconium Aspiration Syndrome (MAS), Hypoxic ischaemic encephalopathy (HIE), and sepsis as compared to thin MSL.

Outpatient Approaches to Elective Induction of Labor

Assessing the feasibility, acceptability and safety of outpatient labour induction. MEDLINE database was searched for "outpatient labor induction" from January 1, 1986 to February 28, 2013. Main outcomes of interest included hyperstimulation, cesarean births, Apgar scores <7 at 5 minutes, arterial-cord pH of <7.10, and neonatal morbidity/mortality. Overall cesarean rates vary significantly (2.6% to 42%). Hyperstimulation with CTG changes is rare. Neonatal admissions for diverse reasons are often not associated with outpatient induction agent. Overall, maternal satisfaction is high. Outpatient labor induction is feasible and important adverse events are rare. However, paucity of available data and heterogeneity of different studies make it difficult to quantify adverse events or identify a preferred induction method.

PL.97 Prospective Audit for Induction of Labour with Propess

Aimto assess the success rate of IOL using propess.MethodA prospective audit of IOL was carried out in a large teaching hospital. Special data sheet was used for collection of data....

Unexpected low apgar score in term neonates

IntroductionApgar score (AS) of less than 7 at 5 minutes after birth may not essentially be associated with significant brain damage but recent studies suggest that it is associated with...

Review of the First 1502 Cases of ECG-ST Waveform Analysis During Labor in a Teaching Hospital

Although electronic fetal monitoring has lowered the rate of intrapartum stillbirth, intrapartum asphyxia still is a major cause of long-term deficits in survivors. A recent Cochrane review found less metabolic acidosis, fewer operative deliveries, and a significant reduction in neonatal encephalopathy (NNE) when performing cardiotocography with ST waveform analysis (CTG-ST). This prospective observational study, carried out at a tertiary referral labor ward, evaluated the STAN™ monitoring system of ST-segment analysis in 1502 women who had a suspicious or abnormal CTG or a high-risk pregnancy. Monitoring entails the application of a fetal scalp electrode that provides continuous CTG and fetal ECG analysis. The ST waveform reflects what takes place during ventricular repolarization. STAN analysis deals with the ability of the fetal heart to adapt to hypoxia, as opposed to fetal blood sampling, which is done to detect acidosis. STAN analysis indicated the need for some action in 358 of the 1502 women in the trial-nearly one-fourth of those studied. In 2.4% of cases, traces could not be interpreted. Cord blood gas values were available in 836 cases, in 23 of which (2.8%) metabolic acidosis was documented. STAN monitoring identified 16 of these cases (70%). In all, 14 cases of NNE were monitored by STAN. A retrospective analysis showed the most frequent reasons for a poor outcome to be delay in taking action when an ST event and CTG called for delivery, and lack of intervention after 90 minutes of active second-stage labor with an abnormal CTG trace despite a normal ST trace. In the authors' experience, the use of ECG-ST waveform analysis to monitor high-risk labors has not altered the frequency of either NNE or emergency operative delivery. More intensive training in CTG and ST analysis appears to be needed, emphasizing the need for prompt action when significant CTG and ST-segment changes are present.

Pushing Method in the Expulsive Phase of Labor

Background. Pushing in the second stage of labor can be forced or follow the spontaneous urge to bear down. Recent studies have shown that spontaneous pushing results in a longer second stage, fewer CTG changes, higher arterial pH and less damage to the birth canal. Method. Randomized trial of spontaneous vs. forced pushing in 350 primiparous women. Results. There was no difference between the randomized groups in duration of second stage of labor, umbilical arterial pH or damage to the birth canal. Of the women allotted to spontaneous pushing, 65.6% used the closed glottis technique for more than half the expulsive phase. When dividing the women into two groups according to the actual pushing technique used most, open or closed glottis, it turned out that women who used the open glottis technique had a shorter second stage of labor and gave birth to infants with lower birth weight.Conclusion. Recommending of spontaneous bearing down during the expulsive phase of labor did not result in a significant diff...

Fetal monitoring by pulse oximetry and CTG

To see if a pulse oximeter can monitor the fetus during labour we recruited 100 Caucasian women in normal uncomplicated labour. Our primary objective was to compare the predictive value of fetal pulse oximetry and cardiotocography using neonatal condition and cord blood acidaemia or hypoxaemia at birth as outcome variables. The fetuses were monitored continuously with a pulse oximeter specifically adapted for fetal use. Five babies had an operative delivery because of an abnormal CTG. Two of these were born in good condition (Apgar score 9 at 1 minute in both cases). The other three babies were delivered in poor condition (Apgar scores of 6 & 9, 5 & 10 and 5 & 10 at 1 and 5 minutes respectively). The oxygen saturation reading only dropped significantly in babies born in poor condition and in one case the drop preempted the CTG changes. These data suggest that pulse oximetry can be adapted to monitor the fetus and has the potential to provide useful information during labour.

Microprocessor based waveform analysis of the fetal electrocardiogram during labor

An increase in T wave amplitude of the fetal ECG (FECG) has experimentally been correlated to elevated catecholamine levels and myocardial glycogenolysis. The FECG changes have also been described during human delivery. The present aim was to investigate whether these ECG changes could be reproduced in an easily handled real time microprocessor system, and to correlate them to biochemical and clinical data. During 40 deliveries the FECG signal was transferred to a microcomputer system for real time averaging of the FECG. There was a high capacity of the system to reproduce the ST waveform changes though the averaging procedure reduced the QRS magnitude by 10%. With a normal umbilical artery pH (⩾7.25) the highest T/QRS ratios recorded during each delivery was 0.26 ± 0.19 (mean ± S.D.). With lowered pH (<7.25) the T/QRS increased to 0.33 ± 0.10 (P < 0.02). A similar difference between the two groups was seen when the T/QRS ratios from the last hour before birth were compared; 0.13 ± 0.08 and 0.18 ± 0.05, respectively (P < 0.01). Changes in the ST waveform with T/QRS ⩾ 0.30, ST segment alterations, or negative T waves appeared during 40% of the deliveries, however, 30% were short standing changes (<30 min). Intermediate CTG changes during at least 30 min occurred in 41% and the pattern was classified as abnormal in 18%. Using the scalp electrode as signal source, the ECG analysis could add further information to the routine CTG recording on the fetal condition during delivery.

ST waveform changes of the fetal electrocardiogram during labour--a clinical study.

Waveform changes in the fetal electrocardiogram (ECG) are under reassessment as a means of fetal surveillance. The purpose of the study was to identify ST waveform changes from the fetal scalp lead during labour and to compare any change with conventional signs of fetal distress. Two scalp electrodes provided a sufficiently stable signal from which ST waveform changes could be identified and measured as the T/QRS ratio. No infant was clinically hypoxic. Only 26% of the 46 patients studied had a continuously normal CTG whereas 67% had no ST waveform abnormalities. A relation was found between the two variables as the mean T/QRS ratio increased from 0.20 (SD 0.11) during epochs of normal CTG to 0.27 (SD 0.17) with CTG changes. A linear correlation (r = 0.58, P less than 0.01) was found between the T/QRS ratio before birth and the cord plasma lactate values.