Antepartum cardiotocography--an audit.

Area of Science:

• Obstetrics and Gynecology
• Fetal Medicine
• Perinatal Health

Background:

• Antepartum fetal surveillance is crucial for identifying at-risk pregnancies.
• Cardiotocography (CTG) is a widely used method for assessing fetal well-being.
• Understanding the predictive value of CTG patterns is essential for clinical decision-making.

Purpose of the Study:

• To evaluate the association between cardiotocography (CTG) fetal reserve patterns and adverse perinatal outcomes.
• To determine the predictive accuracy of a satisfactory CTG pattern for fetal well-being.

Main Methods:

• Prospective monitoring of 9,840 women using antepartum nonstressed cardiotocography (CTG) between 1981 and 1986.
• Classification of CTG patterns into satisfactory, reduced, and critical fetal reserve.
• Statistical analysis to correlate CTG patterns with outcomes such as fetal growth retardation, Apgar scores, perinatal mortality, and Caesarean sections.

Main Results:

• A satisfactory fetal reserve pattern was observed in 91% of cases.
• Reduced and critical fetal reserve patterns were seen in 8% and 1% of cases, respectively.
• Significant increases (p < 0.001) in fetal growth retardation, low Apgar scores, perinatal mortality, and Caesarean sections were associated with worsening CTG patterns.
• Intrauterine growth retardation and/or low urinary estriol excretion were linked to a significantly higher incidence of abnormal CTG traces (14.2%, p < 0.001).

Conclusions:

• A satisfactory fetal reserve pattern on cardiotocography is a reliable predictor of good fetal well-being.
• In the absence of lethal malformations, a perinatal mortality rate of 3/1,000 was observed in patients monitored within 7 days of delivery with satisfactory CTG patterns.
• Cardiotocography is a valuable tool in antepartum fetal surveillance.