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Birth asphyxia and the intrapartum cardiotocograph
K W Murphy1, P Johnson, J Moorcraft
1Nuffield Department of Obstetrics and Gynaecology, Maternity Department, John Radcliffe Hospital, Headington, Oxford.
British Journal of Obstetrics and Gynaecology
|June 1, 1990
Summary
Interpreting intrapartum cardiotocographs (CTGs) poses significant challenges for obstetricians. Abnormalities are common in both asphyxiated and healthy infants, leading to diagnostic difficulties and delayed interventions.
Area of Science:
- Obstetrics
- Neonatal Medicine
- Fetal Monitoring
Background:
- Intrapartum cardiotocography (CTG) is a key tool for fetal well-being assessment.
- Accurate interpretation of CTG is crucial for timely intervention in cases of fetal distress.
- Previous studies indicate variability in CTG interpretation among clinicians.
Purpose of the Study:
- To evaluate the accuracy of intrapartum cardiotocograph (CTG) interpretation in identifying fetal asphyxia.
- To assess inter-observer agreement in CTG analysis.
- To investigate the clinical management and response times associated with abnormal CTG findings.
Main Methods:
- Independent review of CTGs from 38 severely asphyxiated and 120 healthy term infants by three blinded investigators.
- Assessment of cardiotocographic abnormalities and prediction of fetal metabolic acidosis.
- Analysis of fetal blood sampling indications and actual performance.
- Evaluation of staff response times to abnormal fetal heart rate patterns using Krebs' CTG scoring system.
Main Results:
- Good inter-observer agreement was achieved (Kappa = 0.74).
- Cardiotocographic abnormalities were detected in 87% of asphyxiated infants versus 29% of controls.
- Abnormalities were predicted to cause severe metabolic acidosis in 61% of asphyxiated infants and 9% of controls (P < 0.001).
- Fetal blood sampling was indicated more frequently in the asphyxia group but underutilized.
- Median response times for abnormal fetal heart rate patterns were similar for moderate and severe changes (80 min vs. 90 min).
Conclusions:
- Intrapartum CTG interpretation presents significant challenges for practicing obstetricians.
- High rates of CTG abnormalities in both asphyxiated and control groups indicate potential over-interpretation or non-specific findings.
- Delayed and inconsistent clinical responses to abnormal CTGs may impact neonatal outcomes.