Study on Abnormal Cardiotocography (CTG) and Correlation with Fetal Outcomes in BSMMU

Author(s): Dr. Farjana Sarmin, Dr. Sarmin Sultana Swarna, Dr. Dipannita Dhar, Dr. Fatema Akter Doly, Dr. Minara Sikder, Dr. Rubina Bari, Dr. Anjumanara Begum.

Background:

Elaborate Cardiotocography (CTG) is the most commonly used test for antepartum and intrapartum fetal surveillance because it gives information via the cerebro-cardiac response of fetal cerebral activity, which is modified by the hypoxia.

Aim of the study:

Determine the fetal outcomes of abnormal cardiotocography (CTG).

Methods:

This cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. The study duration was one year, from January 2013 to August 2013. The study population was patients having abnormal CTG admitted for delivery in the Department of Obstetrics and Gynecology in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka.

Result:

Majority 19(38.0%) of the patient’s age belonged to 21-25 years and primigravida was predominant. Antepartum CTG was found in 31(62.0%) patients and intrapartum CTG was 19(38.0%) patients. About the indications of CTG, most 9(18.0%) of the patients had pre-eclampsia/chronic hypertension followed by 14.0% had PROM, 12.0% had postdated pregnancy, 10.0% had each IUGR and oligohydramnios respectively. According to types of abnormal CTG more than one third (34.0%) patients had decelerations abnormal CTG, 10(20.0%) had non-reactive (absent of accelerations), 11(22.0%) had tachycardia. According to abnormal fetal heart rate pattern and early neonatal outcome it was observed in this present study that tachycardia was found 11 cases out of which 90.0% in normal outcome and 9.1% abnormal outcome. Nonreactive (absent of accelerations) was found 10 cases out of which 50.0% normal and 50.0% abnormal. Decelerations were found in 17 cases out of which 29.4% in normal and 70.6% in abnormal. Regarding the influence of risk factors on outcomes with abnormal CTG pre-eclampsia /chronic hypertension was found in 9 cases out of which 33.3% and 66.7% had normal and abnormal pregnancy outcome respectively. PROM was found in 7 cases out of which 28.6% normal and 71.4% had abnormal pregnancy outcome. Postdated pregnancy was found in 6 cases out of which 50.0% normal and 50.0% had abnormal pregnancy outcome. Majority (82.0%) of the patients underwent LUCS and 18.0% had vaginal delivery. At 1 min APGAR score <7 was found 30.0% and at 5 minutes APGAR score <7 was 18.0%, small for gestational age was in 34.0% and perinatal morality was found 6.0%.

Conclusion:

CTG can be continued as a good screening test of fetal surveillance but it is not the sole criteria to influence the management of highrisk pregnancies. Abnormal CTG should be supplemented with other test before intervention.