Main Article Content
Aims: To determine the patterns of obstetric decisions based on Cardiotocography (CTG) findings and the effect of these decisions on labour outcomes.
Study Design: Retrospective observational audit.
Place and Duration of Study: Department of Obstetrics and Gynaecology, Babcock University Teaching Hospital, Ilishan-Remo. Data were obtained from all intrapartum CTG tracings done from January 2016 to December 2018.
Methodology: A consecutive sampling technique was used and the case files, delivery register and follow up records of all included CTG tracings were used to obtain maternal and perinatal data. Data were analyzed using the SPSS version 21.0. Numerical data were expressed as mean ± standard deviation (SD). The Chi-square test was used to compare categorical variables while the independent T-test was used to compare means of groups studied. Binary logistic regression was used to assess the factors related to maternal and perinatal outcomes. The level of statistical significance was be set at p-value of <0.05.
Results: There were 756 deliveries, but only 436 CTGs met the inclusion criteria. The prevalence of abnormal CTG was 130/436 (29.8%); 93/436(21.3%) were suspicious while 37/436 (8.5%) were pathological. On the basis of CTG; 300/436 (68.8%) of the parturients had intermittent fetal heart tone auscultation, 100/436 (22.9%) had continuous Electronic fetal monitoring (EFM) while labour was stopped in 36/436 (8.3%). The 5th minute APGAR score did not depend on the admission CTG finding (0.55), the decision to stop or continue labour (p=0.26) or the use of continuous EFM (P=0.66). Maternal near miss (MNM) was not a consequence of the decision to stop labour (P=0.98) or the use of continuous EFM (P=0.19). The mode of delivery outcome was however a consequence of decisions to continue or stop labour (P <0.001, AOR=0.202, 95%CI=0.153-0.265). Pregnancy risk was a consistent determinant of maternal outcomes; occurrence of MNM (P <0.001, AOR=0.002, 95%CI=0.000-0.032) and mode of delivery (P <0.001, AOR=0.015, 95%CI=0.005-0.043).
Conclusion: Decisions based on admission CTG was associated with a high rate of operative deliveries, without any significant effect on fetal or maternal outcomes. CTG in labour should be restricted to pregnancies adjudged as high risk based on obstetric factors and CTG should be used as an adjunctive triaging instrument.
Devane D, Lalor JG, Daly S, McGuire W, Cuthbert A, Smith V. Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal well-being. Cochrane database of Systematic Reviews. (1). Art: CD 005122. Pub.5. John Wiley and Sons. Ltd; 2017.
DOI: 10.1002/14651858. CD005122
Das V, Katiyar N, Malik GK. Role of admission test. J Obstet Gynecol India. 2001;51(1):48-50.
Thapa J, Sah R. Admission cardiotocography in high risk pregnancies. NJOG. 2017;23(1):50-54.
National institute for health and care excellence. Intrapartum Care: NICE Guideline CG190; 2017.
[Accessed on 23/04/2018]
Shriver EK. What is a high-risk pregnancy? Healthy pregnancies, healthy children and optimal lives. National Institute of Child Health and Human Development.
Available:https://www.nichd.nih.gov/health/topics/pregnancy/conditionsinfo/high-risk [Accessed on 26/09/2019]
Say L, Souza JP, Pattinson RC. WHO working group on maternal mortality and morbidity classification. Maternal near miss-towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol. 2009;23:287-296.
Dwarakanath L, Lakshmikantha G, Chaitra SK. Efficacy of admission cardiotocography (admission test) to predict obstetric outcome. J. Evol Med Dental Sci. 2013;2(5):418-423.
Sartwelle TP. Electronic fetal monitoring: A defense lawyer’s view. Rev Obstet Gynecol. 2012;5(3/4):e121-e125.
Alfirevic Z, Devane D, Gyte GM. Continuous Cardiotocography (CTG) as a form of Electronic Fetal Monitoring (EFM) for fetal assessment during labour. Cochrane Database of Systematic Reviews. 2013;31(5):CD006066.
Vintzileos AM, Nochimson DJ, Guzman ER, Knuppel RA, Lake M, Schifrin BS. Intermittent electronic fetal heart rate monitoring versus intermittent auscultation: A meta-analysis. Obstet Gynecol. 1995;85: 149-55.
O’Mahony F, Hofmeyr GJ, Menon V. Choice of instruments for assisted vaginal delivery. Cochrane Database Syst Rev. 2010;10(11):CD005455.
Ayres-de-Campos D, Bernardes J, Costa-Pereira A, Pereira-Leite L. Inconsistencies in classification by experts of cardiotocograms and subsequent clinical decision. BJOG. 1999;106:1307-10.
Blackwell SC, Grobman WA, Antoniewicz L, Hutchinson M, Gyamfi-Bannerman C. Interobserver and intraobserver reliability of the NICH 3-tier fetal heart rate interpretation system. Am J Obstet Gynecol. 2011;205:378.e1-5.
Rahman H, Renjhen P, Dutta S. Reliability of admission cardiotocography for intrapartum monitoring in low resource setting. Niger Med J. 2012;53(3): 145-149.
Fawole AO, Sotiloye OS, Oladimeji AO, Alao MO, Hunyinbo KI, Sadoh EA, Otolorin EO. Antenatal cardiotocography: Experience in a Nigerian tertiary hospital. Nigerian Postgraduate Medical Journal. 2008;15:19-23.
Desai D, Maitra N, Patel P. Fetal heart rate patterns in patients with thick meconium staining of amniotic fluid and its association with perinatal outcome. Int J Reprod Contracept Obstet Gynecol. 2017; 6(3);1030-1035.
Nelson KB, Dambrosia JM, Ting TY, Grether JK. Uncertain value of electronic fetal monitoring in predicting cerebral palsy. N Engl J Med. 1996;334:613-618.
Barrett JF, Jarvis GJ, Macdonald HN, et al. Inconsistencies in clinical decisions in obstetrics. Lancet. 1990;336:549-551.
Spencer JA. Clinical overview of cardiotocography. Br J Obstet Gynaecol. 1993;100(9):4-7.
Kamal B, Deepika D, Padmaja V. Admission test as predictor of fetal outcome. J Obstet and Gynaec of India. 1999;49(2):36-37.
Ingemarsson I, Arulkumaran S, Ingemarsson E, Tambyraja RI, Ratnam SS. Admission test a screening test for fetal distress in labour. Obstet Gynecol. 1986;68(6):800-806.
Ayres-de-Campos D, Bernardes J, Marsal K, Nickelsen C, Makarainen L, Banfield P, et al. Can the reproducibility of fetal heart rate baseline estimation be improved? Eur J Obstet Gynecol Reprod Biol. 2004;112: 49-54.