Introduction

Cardiotocography was incorporated into clinical obstetrics to reduce both antepartum and intrapartum mortality and morbidity. Antipartum and intrapartum monitoring has improved fetal outcome and normal survival is now possible in cases considered hopeless years ago. The enduring challenge of the obstetrician lies in the need to care for two patients simultaneously, one the mother who can express her problems and the other the fetus who is hidden from our view and unable to express the same. The primary goal of antenatal evaluation is to identify fetuses at risk for intrauterine injury and death so that intervention and timely delivery can prevent progression to stillbirth or neonatal death. Ideally, antenatal tests would decrease fetal death. Not all mothers or babies are blessed with trouble-free gestation.[1] [2]

Cardiotocography (CTG) is continuous electronic monitoring of the fetal heart rate along with a recording of fetal movements. It is a non-invasive procedure which can help us assess the fetal condition. The Cardiotocography derives from the seminal report that accelerations are a reliable sign of fetal well-being [3]. Prolonged second stage of labour and repeated late deceleration on CTG tracings in low-risk populations were predictors of APGAR scores at 5min of<7, a situation that was strongly associated with increased risk of neonatal respiratory distress and need for mechanical

ventilator support and NICU. In addition APGAR at 5min <7 was strongly associated with Hypoxic ischemic encephalopathy and consequently cerebral palsy.[4] Nonreassuring fetal heart rate (FHR) patterns or categories of the three tire interpretation systems of FHR, based on the National Institute of Child Health and Human Development (NICHD) workshop suggestion on electronic monitoring of FHR include bradycardia, tachycardia, lack of acceleration, lack of variability and periodic or episodic deceleration (recurrent variable deceleration, prolong deceleration, and late deceleration with baseline variability).[5] [6] Cardiotocography (CTG) is known as a tool to assess the fetus during labor.[7] Studies have shown that asphyxia and hypoxic-ischemic encephalopathy (HIE) in 79% of cases were associated with an abnormal CTG. [7]

3. Severe intrapartum hemorrhage
4. Comorbidities like DM.HTN.HF, CKD etc

The procedure of preparing and organizing materials: The selection of cases according to inclusion and exclusion criteria and findings of observation were recorded on the prescribed data collection form.

Types of equipment to be used: CTG machine, standard ruler, monitor, and data collection sheet.

Procedure of data analysis of interpretation: After collection, data was edited, and analyzed on a computer by using SPSS version 20 software.

Quality assurance strategy: All efforts were made to reduce likelihood of important errors which compromise essential integrity of research data. For that purpose, at first, a sample size was selected. Then manual work was done. An easily understandable questionnaire was presented to respondents so that they were able to understand questions easily and answer accordingly.

Results

Table 1: Sociodemographic features

Table-1 showing different sociodemographic profiles where the majority of women were in the age group 21-25 years, working as housewives and found to be from urban areas with lower-middle-class status.

Table 2: Descriptive variables

No seizures within 24-48 hours and no cases of perinatal death.

Table 7: Outcome of the fetus

Discussion

Cardiotocography is a simple, safe, non-invasive and economical investigation which can be done on every patient in labour. This test should be a part of antepartum and intrapartum fetal surveillance conducted on every patient as a part of admission. The abnormal patterns are recognized and necessary and timely intervention is done, thereby saving mother and fetus. Admission cardiotocography is widely used to identify pregnancies that might benefit from continuous fetal monitoring in labour. A study of antenatal CTG in Nigeria concluded that the non-reactive CTG was a valuable tool for early detection of fetal compromise.[9] It had a modest predictive value for soft outcomes such as mild asphyxia, a diagnosis of fetal distress, and operative delivery, particularly in the next few hours.[10] Different sociodemographic profiles where the majority of women were in the age group 21-25 years, working as housewives and found to be from rural areas with lower and lower-middle-class status. These are some common demographic findings that are expected from the context of Bangladesh. Different descriptive variables where the average gestational age was 38 weeks and the mean height of the uterus was 36 cm. Among all 50 (100%) Patients were presented with vertex presentation. Different cardiotocographic findings were normal was found in 34 (68%) cases. Abnormal was found in 16 (32%) cases.Among 50 cases 34(68%) had normal vaginal delivery and 16(32%) cases undergone CS.Among 34 cases with reassuring CTG findings, 13 cases were preterm (34 to 36 weeks), 17 cases were term (37 to 40 weeks) and 4 cases were postdated (more than 40 weeks). Preterm cases were managed conservatively and delivered at term.

References