Intrapartum cardiotocography and its correlation with umbilical cord blood pH in term pregnancies: a prospective study

Background: The purpose of intra-partum fetal monitoring is to identify early signs of developing hypoxia. Electronic fetal monitoring is performed using cardiotocograph, which is a paper record of the fetal heart rate (FHR) patterns plotted simultaneously in relation to uterine activity. In low resource settings umbilical cord artery blood gas analysis can provide important information about the foetuses exposed to intrapartum hypoxaemic events and can distinguish the infant at high risk for asphyxia and related sequelae. The aim of this study was to correlate intrapartum CTG findings with umbilical cord blood pH at birth in term pregnancies in labour and thus evaluate the success of CTG in predicting fetal acidosis during labour.Methods: The present study included 301 consecutive women with term singleton pregnancies in labour. Intrapartum CTG was taken and classified into normal (category I trace), indeterminate (category II trace) and abnormal (category III trace) according to NICHD 2008 Classification (Adapted by ACOG 2013). Umbilical cord arterial blood was taken immediately after birth, in a pre-heparinised syringe and sent to the laboratory for pH study to detect acidosis. Cord blood pH <7.2 was taken as acidosis and cord blood pH ≥7.2 was taken as normal.Results: In this study, 50.2% of the women had normal CTG, 36.5% had indeterminate CTG and 13.3% had abnormal CTG. 18.3 % of the babies had acidosis. Out of the subjects with abnormal intrapartum CTG, 52.5% had acidosis, of the subjects with normal intrapartum CTG trace, 7.3% had acidosis and of the 110 subjects with indeterminate intrapartum CTG, 22.7% had acidosis. A statistically significant association was found between intrapartum CTG and umbilical cord arterial pH (p <0.001).Conclusions: From the analysis of this study, it can be concluded that an abnormal CTG should be managed appropriately, without delay, in order to prevent acidosis in the neonate and adverse long-term sequelae. The obstetrician should be more vigilant in cases of indeterminate CTG tracings and monitor such labours closely.

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TO STUDY THE CATEGORY II CARDIOTOCOGRAPHY AND ITS CORRELATION WITH UMBILICAL CORD PH

International Journal of Advanced Research ◽

10.21474/ijar01/11937 ◽

2020 ◽

Vol 8 (10) ◽

pp. 1086-1091

Author(s):

Sonal Behra ◽

◽

Namita Agarwal ◽

Mridu Sinha ◽

J.K Goel ◽

...

Keyword(s):

Cord Blood ◽

Umbilical Cord ◽

Blood Gas Analysis ◽

Fetal Monitoring ◽

Gas Analysis ◽

Arterial Blood ◽

Blood Ph ◽

Electronic Fetal Monitoring ◽

Paper Record ◽

Fetal Acidosis

Introduction: The purpose of intra-partum fetal monitoring is to identify early signs of developing hypoxia. Electronic fetal monitoring is performed using cardiotocograph, which is a paper record of the fetal heart rate (FHR) patterns plotted simultaneously in relation to uterine activity. In low resource settings umbilical cord artery blood gas analysis can provide important information about the fetuses exposed to intrapartum hypoxaemic events and can distinguish the infant at high risk for asphyxia and related sequelae. The aim of this study was to correlate intrapartum CTG findings with umbilical cord blood pH at birth in term pregnancies in labour and thus evaluate the success of CTG in predicting fetala cidosis during labour. Methods:The present study included 100 women with term singleton pregnancies in labour and with Category II according to NICHD 2008 Classification (Adapted by ACOG 2013). Umbilical cord arterial blood was taken immediately after birth, in a pre-heparinised syringe and sent to the laboratory for pH study to detect acidosis. Cord blood pH <7.2 was taken as acidosis and cord blood pH ≥7.2 was taken as normal Results: Among 100 patients, 78 had normal cord pH and 22 had abnormal cord pH(<7.20). On intrapartum CTG, maximum patients in our study group had variable decelerations,followed by decreased variability(<5bpm) and absent induced acceleration on fetal stimulation. Late decelerations and fetal bradycardia were observed to have most significant correlation with fetal acidosis. Conclusions: From the analysis of this study, it can be concluded that an abnormal CTG should be managed appropriately, without delay, in order to prevent acidosis in the neonate. The obstetrician should be more vigilant in cases of Cat II CTG tracings with bradycardia and late decelerations and monitor such labours closely.

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Correlation between Intrapartum Cardiotocogram findings and cord blood pH in term and preterm labors

Current Women s Health Reviews ◽

10.2174/1573404817666210811124304 ◽

2021 ◽

Vol 17 ◽

Author(s):

Shubha Rao ◽

Himanshi Jain ◽

Anjali Suneel ◽

Roopa Padavagodu Shivananda ◽

Akhila Vasudeva

Keyword(s):

Cord Blood ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Preterm Labor ◽

Fetal Monitoring ◽

Cord Blood Sample ◽

Arterial Blood ◽

Blood Ph ◽

Preterm Group ◽

Fetal Acidosis

Background: The purpose of intrapartum fetal monitoring by cardiotocograph (CTG) is to identify early signs of developing hypoxia so that appropriate action can be taken to improve the perinatal outcome. Although CTG findings are well known to monitor the progress of the labor due to the paucity of recommendations, there has always been a clinical dilemma as the term fetuses respond differently than a preterm fetus. However, umbilical cord blood pH can distinguish the infant at high risk for asphyxia and related sequel. Therefore, because of differences in fetal physiology in term and preterm fetuses, CTG findings vary, and hence the validity of CTG to determine fetal acidosis should be different. Aims and Objectives: This study aimed to correlate abnormal intrapartum CTG findings with umbilical cord blood pH in term and preterm labor and thus evaluate the success of CTG in predicting fetal acidosis during labor. Methods: The present study included 210 women in labor (70 preterm and 140 term) with abnormal intrapartum CTG that was classified as per 2015 revised International Federation of Gynecologists and Obstetrician (FIGO) guidelines. Immediately after delivery 2 ml Umbilical artery cord blood sample was taken in a pre-heparinized syringe for analysis, pH <=7.2 was taken as acidosis and pH >7.2 was taken as normal. The measured data were maternal general characteristics which included gravida status, associated comorbidities, method of induction and character of liquor, the intrapartum CTG tracings recorded the cord arterial blood pH and the neonatal characteristics such as APGAR score and neonatal outcome. Results: Data from 70 preterm labor was compared with 140 term labor. In this study, 20.9 % of the babies had acidosis. Suspicious CTG due to decreased variability were more common in the preterm group than in the term group (21.4% vs. 8.6% p<0.05). Positive predictive value (PPV) of abnormal CTG for fetal acidosis in the preterm group was found to be higher than that in term group, PPV of pathological CTG being even higher than suspicious CTG. Women with suspicious CTG had 82 % less risk of fetal acidosis as compared to pathological CTG. Women with Bradycardia had 5.9 times the risk of fetal acidosis as compared with normal and tachycardia. Conclusion: Abnormal CTG should be managed appropriately without any delay to prevent acidosis and cord blood pH should be done in all labors with abnormal CTG. However, our findings of a higher incidence of lower cord blood pH and suspicious CTG due to decreased variability alone, highlight the limitation of criteria currently used for interpretation of CTG in preterm labors.

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Umbilical cord blood gas analysis in augmented labour

Journal of Obstetrics and Gynaecology ◽

10.1080/01443619965930 ◽

1999 ◽

Vol 19 (1) ◽

pp. 38-40 ◽

Cited By ~ 1

Author(s):

C. Loghis, E. Salamalekis, N. Vitorato

Keyword(s):

Cord Blood ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Blood Gas

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Study of intrapartum fetal distress with the help of cardiotocography and its correlation with umbilical cord blood sampling

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20201227 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1580

Author(s):

S. Neeraja ◽

Sugathi Parimala ◽

Naima Fathima

Keyword(s):

Cord Blood ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Neonatal Morbidity ◽

Fetal Distress ◽

Risk Groups ◽

Normal Vaginal Delivery ◽

Arterial Blood ◽

Blood Ph ◽

Fetal Acidosis

Background: Even in low risk mothers, fetal acidosis occurs as in high risk groups. Aim of fetal monitoring is to detect early response to intrauterine hypoxia and prevent irreversible neurological damage and death. Objective of this study was to correlate the intrapartum fetal distress with the help of cardiotocography CTG with umbilical cord blood sampling.Methods: A total 100 consecutive patients attending the labor ward were studied. Immediately at birth, before the baby’s first breath and before delivery of the placenta, the umbilical cord blood was collected as per the standard guidelines laid down in the standard textbooks. Fetal acidosis was assessed by umbilical cord arterial blood pH. Fetal acidosis was considered when umbilical artery pH <7.2. Cardiotocography features were used to clinically diagnose fetal distress.Results: Most of the mothers were multigravida. They belonged to the age group of 20-25 years. Only 18% had abnormal CTG. Out of 50 mothers with normal vaginal delivery, all had normal CTG. Out of 43 mothers who were delivered by LSCS, no one had normal CTG, 25 had indeterminate CTG and 18 had abnormal CTG. As CTG became abnormal, proportion of mothers with the thick meconium increased. NICU admission proportion increased as CTG changed from normal to the abnormal. There was a significant association between the abnormal CTG and the umbilical cord blood pH being acidic.Conclusions: CTG is a simple test, easy to perform and can alert obstetrician for necessary interventions in case of an abnormal CTG. It can detect fetal distress in labor thus helping to reduce neonatal morbidity by early intervention in cases of abnormal tracing.

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