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Nonstressed antepartum cardiotocography in patients undergoing elective cesarean section--fetal outcome
Insights
Clinical indications for antepartum cardiotocography effectively identify high-risk pregnancies. Abnormal cardiotocography results indicate a fetus at risk of hypoxia, necessitating close monitoring for fetal well-being.
Area of Science:
- Obstetrics and Gynecology
- Fetal Monitoring
- Perinatal Medicine
Background:
- Antepartum cardiotocography (CTG) is a key tool for assessing fetal well-being.
- Identifying pregnancies at higher risk for adverse outcomes is crucial for timely intervention.
Purpose of the Study:
- To evaluate the effectiveness of clinical indications in selecting high-risk pregnancies for antepartum cardiotocography.
- To determine the association between abnormal CTG findings and adverse perinatal outcomes.
Main Methods:
- Prospective study of 409 patients undergoing elective cesarean section.
- Comparison of outcomes between patients with and without clinical indications for CTG.
- Analysis of cardiotocography results, fetal growth, neonatal deaths, cord arterial blood pH, and Apgar scores.
Main Results:
- Patients with clinical indications for CTG showed higher rates of abnormal CTG, fetal growth retardation, and neonatal deaths.
- Abnormal CTG findings were associated with significantly lower cord arterial blood pH and Apgar scores.
- Cardiotocographic evidence of critical reserve was identified in 10% of patients tested for clinical indications.
Conclusions:
- Clinical indications effectively identify pregnancies requiring fetal well-being assessment via CTG.
- Abnormal antepartum cardiotocography is a significant indicator of fetal hypoxia risk.
- CTG plays a vital role in managing high-risk pregnancies and preventing adverse perinatal outcomes.
Abstract:
In a prospective study of 409 patients monitored with nonstressed antepartum cardiotocography and delivered by elective cesarean section, cardiotocography was requested for 170 because of clinical indications. This group had higher incidences of abnormal cardiotocography (p less than 0.001), fetal growth retardation (p less than 0.001) and neonatal deaths (p less than 0.025) than had the group without such requests, suggesting that clinicians effectively selected the high-risk pregnancy for testing of fetal well-being. Cardiotocographic evidence of critical reserve was found in 17 of 170 patients (10%) tested for a clinical indication and in none of the 239 patients in the control group. Patients with abnormal cardiotocography results had significantly higher incidences of cord arterial blood pH less than 7.26 (p less than 0.05) and Apgar scores of less than 6 at 1 minute (p less than 0.001), showing that an abnormal cardiotocogram is indicative of a fetus at risk of having hypoxia.