Do cardiotocographic changes alone determine fetal outcome?

ABSTRACT

To compare fetal outcome in fetal distress on CTG with clear liquor versus CTG changes of fetal distress with meconium stained liquor. A cross sectional study. The Department of Obstetrics and Gynecology Islamic International Medical Complex. September2004 to December 2005[16 month]. During the study period 111 patients delivered in which fetal distress was diagnosed clinically and on cardiotocography [CTG]. Vaginal delivery [spontaneous or instrumental] was accomplished in 17 [15%] patients while the rest of 94 [85%] patients underwent emergency caesarean section for fetal distress. Irrespective of the mode of delivery, the patients were divided into two Groups; Group A and Group B. Group A comprised of those patients who had fetal distress on CTG with clear liquor and Group B included those patients who had fetal distress on CTG along with meconium staining of liquor. There were 67 patients in Group A and 44 patients in Group B. Out of the 94 patients who underwent caesarean section, 57 patients were operated for fetal distress on CTG with clear liquor and 37 patients had CTG changes with meconium staining of liquor. CTG changes noted included loss of beat to beat variability, tachycardia, bradycardia and decelerations. Demographic details noted were maternal age, parity, fetal weight and mode of delivery. Main outcome measures noted were CTG, Apgar score at 1 and 5 minutes, baby resuscitation measures and neonatal complications. The main outcome measures were expressedas numbers and percentages. Mean maternal age in Group A and Group B was 26.10 years and 25.57 years respectively Mean gestational age was 38 weeks in Group A and 39 weeks in Group B. Birth weight was 3.2 kg and 3.1 kg in Group A and Group B respectively. Main outcome measures showed more variable and late decelerations, [23% vs 8%] more babies with lower apgar scores [18% vs 6%] and more neonatal complications in Group B. There were two neonatal deaths in Group B. Meconium staining with CTG changes is a more significant sign of fetal distress than CTG changes alone