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PubMed1986

Abnormal antepartum cardiotocography and major fetal abnormalities.

A 10-year experience of antepartum cardiotocography (8,463 pregnancies) was reviewed to examine the associations with major fetal malformations (278 cases or 3.3%). Patients with critical fetal reserve cardiotocography had a 72% Caesarean section rate (91 of 126) and major fetal malformations were present in 19% (24 of 126) of their infants. Although only 10 of the total 278 malformations (3.6%) were lethal, 6 of these 10 (60%) were associated with a critical reserve antepartum cardiotocographic pattern. As delivery by Caesarean section is usual in patients with critical fetal reserve cardiotocography, it is mandatory to perform ultrasonography to exclude identifiable lethal fetal malformations before delivery.

Cesarean Section↗

PubMed2006

Admission cardiotocography versus intermittent auscultation of fetal heart rate: effects on neonatal Apgar score, on the rate of caesarean sections and on the rate of instrumental delivery--a systematic review.

OBJECTIVE: The aim of this review was to determine whether intrapartum admission cardiotocography (CTG) in women at low obstetric risk can improve neonatal outcome (in terms of Apgar score) and whether it is associated with an increase in the incidence of instrumental delivery and caesarean section. REVIEW METHODS: The Cochrane Library, Medline (1966-November 2005), Embase (1980-November 2005) and the PubMed were searched for randomized control trials and systematic reviews of randomized control trials. Studies were assessed for quality. Outcomes considered the neonatal Apgar score at 5 min after delivery, caesarean section and instrumental delivery. A meta-analysis of the results of the randomized controlled trials was performed. RESULTS: The pooled relative risk for having an Apgar score less than 7 points at 5 min after delivery was higher in the admission CTG group (RR 1.35, 95% CI 0.85-2.13) but it was not statistically significant. The pooled relative risks for having a caesarean section-delivery (RR 1.2 95% CI 1.00-1.41) and an instrumental delivery (RR 1.1 95% CI 1.00-1.18) were both higher in the admission CTG group. Both these were statistically significant. CONCLUSION: Intrapartum admission cardiotocography in women at low obstetric risk increases the risk of caesarean section and instrumental delivery. In addition, there is no evidence for neonatal benefit in terms of Apgar score at 5 min after delivery. A larger sample size would be needed in order to answer this important question.

Apgar Score↗

PubMed2002

Intrapartum cardiotocography and fetal pulse oximetry in assessing fetal hypoxia.

OBJECTIVES: A retrospective analysis of short-term variability (STV), a cardiotocography (CTG) parameter, in relation to fetal blood saturation values (FSpO(2)) obtained by fetal pulse oximetry. METHODS: The study included 26 healthy pregnant women monitored continuously during delivery with both cardiotocography and fetal pulse oximetry. RESULTS: Lower FSpO(2) values were observed in the group showing STV levels 6.0 ms (34.4+/-2.9% vs. 43+/-7.2%; P<0.001). A positive correlation was found between STV levels <or=6.0 ms and mean FSpO(2) values in the 2nd stage of labor. CONCLUSIONS: 1. A significant relationship was observed between short-term variability in the cardiotocographic records and fetal blood saturation levels in the 2nd stage of labor. 2. Fetal pulse oximetry can be valuable in assessing fetal wellbeing, especially when CTG records are abnormal.

Cardiotocography↗

PubMed1992

[Telemetric cardiotocography--clinical value and limits of the method in routine monitoring].

Cardiotocography by external telemetry and maternal ambulation has been compared to the usual recording in recumbent position. The visual interpretation extended to several items, such as technical quality, CTG scoring, contractions and foetal activity, which were interpreted for single groups of gestational age and diagnosis. A questionnaire of the patients joined with this study, referring to the acceptance of cardiotocography, definitely voted for the telemetrical method. As to the valuation of the cardiotocograms (CTGs), it was necessary to consider a slight restriction of the undulation of the foetal heart rate by telemetry. Referring to the technical quality of the CTGs, the telemetrical method was inferior in all points while recording in recumbent position. Problems appeared to occur especially with adipose gravidas. In patients with toxaemia, we noticed a tendency to increasing systolic blood pressure combined with growing restriction of foetal undulation by telemetrical recording. The use of external telemetry with maternal ambulation at other diagnostical situations should depend only on technical quality and maternal acceptance of telemetry, since there are no differences with respect to information.

Adolescent↗

PubMed1994

Value of cardiotocography in women with antepartum haemorrhage--is it too late for caesarean section when the cardiotocograph shows ominous features?

Caesarean section is thought to be indicated by an ominous antepartum cardiotocograph (CTG). However, the fear remains that infants delivered for this indication in the presence of antepartum haemorrhage, especially when premature, are destined to have severe hypoxic neurological damage. We therefore reviewed our experience of cardiotocography in women with antepartum haemorrhage (APH) from 1989 to 1992. There were 472 women with APH who had a CTG performed. Of them, 68 had abruptio placentae and 317 had an APH of undetermined cause. For the group with abruptio placentae, the perinatal mortality rate (PMR) was 230.7 per 1,000 when the CTG was abnormal, but only 18.2 per 1,000 if the CTG was normal (odds ratio 16.2, 95% confidence interval [CI] 1.53-171.9, p = 0.02). For APH of undetermined cause, the corresponding rates were 90.9 per 1,000 and 9.8 per 1,000 (odds ratio 10.1, 95% CI 0.96-105.8, p = 0.13). There were no perinatal losses in women with APH due to placenta praevia (87 cases). There were 6 cases of critical fetal reserve identified on a CTG in women with abruptio or APH of undetermined cause. All were delivered by Caesarean section, with 4 surviving infants, 3 with normal neurological outcome and 1 lost to follow-up. There were 3 cases of APH resulting in an infant with cerebral palsy, all of whom had had a normal antepartum CTG. Our data suggest that cardiotocography allows pregnancy to be safely prolonged in pregnancies complicated by abruptio placentae or APH of undetermined cause, and that Caesarean section is an appropriate form of delivery when the CTG becomes abnormal in these cases.

Abruptio Placentae↗

PubMed2003

[Cardiotocography in pregnancies with absent or reversed end-diastolic velocity in the umbilical arteries: analisys of perinatal outcome].

OBJECTIVES: To study the correlation between cardiotocography parameters and perinatal outcome in pregnancies with absent or reversed end-diastolic velocity (AERDV) in the umbilical arteries. METHODS: One hundred and twenty-seven cases presenting with AREDV followed between 1993 and 2000 were selected for analysis. The last cardiotocographic tracing performed on the day of delivery was reviewed and the following parameters were considered: magnitude of long-term variability, presence or absence of acceleration, late deceleration, variable deceleration, prolonged deceleration, pseudo sinusoidal pattern and the classification in normal, suspected and abnormal tracing. RESULTS: A significant (p<0.05) association was found between abnormal tracing and acidemia at birth (pH inferior to 7.20) with 71.9%, first minute Apgar score inferior to seven (73.4%), newborn intubation at delivery (64.1%), and early neonatal death (20.3%). The absence of acceleration was associated (p<0.05) to acidemia at birth (58.8%), first minute Apgar score inferior to seven (67.7%), newborn intubation at delivery (51%) and neonatal death (29.4%). Low FHR variability (<5bpm) was associated to (p<0.05): acidemia at birth (88.5%), newborn intubation at delivery (69.2%), early neonatal death (34.6%) and neonatal death (42.3%). Late decelerations were significantly (p<0,05) related to acidemia at birth.(78.2%). The severe variable deceleration was associated to (p<0.05): acidemia at birth (79.3%), newborn intubation at delivery (69%) and early neonatal death (17.2%). Prolonged deceleration was associated to (p<0.05) newborn intubation at delivery (70.6%). Pseudo sinusoidal pattern was associated to (p<0.05) early neonatal death (60%). CONCLUSION: The AREDV represents a severe fetal compromise with high risk to neonatal morbidity and mortality, and correlation between cardiotocography abnormalities and adverse perinatal outcome was demonstrated.

Acidosis↗

PubMed1999

[Validity of cardiotocography in the detection of umbilical cord complications].

OBJECTIVE: The purpose of this study was to investigate the validity of cardiotocography for the detection of cord complications. MATERIAL AND METHODS: A low-risk population of 4196 cases was selected in which cord complications have been recognized in 34.3%. Cases with cord complications and controls were paired by parity, gestational age, maternal age and mode of delivery. 25 pairs were randomly selected. 50 tracings were presented twice to 4 obstetricians in a double-blind manner. As parameters for the determination of the validity of fetal monitoring the reliability, positive (ppv) and negative predictive value (npv), sensitivity and specificity were used. Inter- and intra-observer variability were also examined. RESULTS: Reliability 52%, ppv 52%, npv 52%, sensitivity 46%, specificity 58%. Interobserver variability: All 4 obstetricians agreed in 47 of 100 evaluations. The level of agreement was higher in the controls (63%) than in the cord complication group (56%). The intraobserver variability was 25%. CONCLUSIONS: Cardiotocography is not useful for the detection of cord complications. The range of possibilities has not been exploited yet, even for the evaluation of the fetal state.

Cardiotocography↗

PubMed1989

[Cardiotocography in intrauterine growth retardation].

Fifty seven cases of intrauterine growth retardation were analyzed at the Department of Perinatal Medicine, "Luis Castelazo Ayala" Hospital, IMSS. The main purpose of the study was to establish the usefulness of cardiotocography in the decision of pregnancy interruption. The patients were divided in three groups in relation to the last non stress test made before delivery (reactive, non reactive, non reactive, non reactive with declarations). It is concluded that cardiotocography is a useful procedure for the surveillance of these fetuses and it was found a good correlation between progressively ominous traces and fetal condition at birth.

Abortion, Induced↗

PubMed1993

[The intensity of fetal movements vs. amnioscopy and cardiotocography in assessing fetal well-being].

In 1989 at the Hospital Civil of Guadalajara we make a study with 100 patients with a term pregnancy, initial labor and alive fetus. At all women we practiced interrogatory about subjective intensity of fetal movements, amnioscopy and cardiotocographic registry and we compare results with Apgar score of the newborns at minute and five minutes. The fetal movements were normal in 91% of which 95.7% had Apgar score > or = 7 at minute and 98.9% Apgar score > or = 8 at five minutes; clear amniotic fluid in 75% of which 94.6% had Apgar score > or = 7 at minute and 100% had Apgar > or = 8 at five minutes and 94% with normal cardiotocographic registry of which 95.7% had Apgar score > or = 7 at minute and 100% had Apgar score > or = 8 at five minutes. In the distress fetal prediction, the best method was the cardiotocography and the worse was the meconial amniotic fluid. We conclude that the subjective intensity of fetal movements are similar in the well-being fetal prediction to the amnioscopy and cardiotocography and the physicians must use it in the obstetric care.

Adolescent↗

PubMed1985

[Cardiotocography with or without fetal blood analysis].

It is the aim of obstetric medicine to achieve optimum safety for both mother and child with a minimum of surgery. In normal clinical routine, this demand cannot be fully met by the sole use of cardiotocography for monitoring the foetus sub partu. Obviously the weak point of cardiotocographical diagnosis is that often there is no imminent or beginning hypoxia or acidosis of the foetus associated with suspicious or pathological heartbeat patterns. This results in a large number of unnecessary deliveries by Caesarian section, or complicated vaginal surgery. We must draw the conclusion from this that cardiotocography is merely a-selective method. It is imperative to apply additionally a biochemical method for properly diagnosing foetal hypoxia or acidosis. The author also comments on accusations made by K. Hammacher in a preceding publication.

Acid-Base Equilibrium↗

PubMed1985

Non-stress antenatal cardiotocography--a prospective blind study.

A prospective blind study of non-stress antenatal cardiotocography was undertaken in a group of 216 'high risk' pregnancies. The 'Cardiff' scores and the outcome of the pregnancies were compared subsequently. Low scores were associated with infants that were small-for-gestational age and fetal distress in labour, while high scores were associated with normal intrauterine growth. Although antepartum cardiotocography is predictive of fetal and neonatal outcome the extent to which its availability will prevent adverse outcome appears limited.

Female↗

PubMed1985

Non-stress antenatal cardiotocography--a prospective randomized clinical trial.

A randomized controlled trial examined the effects of non-stress antepartum cardiotocography on obstetric management and assessed its usefulness as a diagnostic test of fetal compromise. Daily cardiotocograph recordings were made in 396 antenatal patients at increased risk of fetal compromise but were withheld from the clinicians responsible for care in half the cases. The frequency of intrapartum fetal distress and low Apgar score was similar in the two groups. The three normally-formed perinatal deaths all occurred in the revealed group but in only one case could earlier obstetric intervention have altered the outcome. Availability of non-stress cardiotocography was not associated with an increased rate of induction of labour or caesarean section.

Adolescent↗

PubMed1986

The effect of maternal ethanol intoxication on fetal cardiotocography: a report of four cases.

Fetal cardiotocography revealed no or poor variability and no reactivity to fetal movements and or external stimuli in four drunken women. This was taken as a sign of fetal hypoxia in one patient and led to emergency caesarean section although, the infant was not hypoxic. In the other three patients, cardiotocography normalized within 11-14 h when the mothers became sober.

Adult↗

PubMed1986

Timely diagnosis by cardiotocography of critical fetal reserve due to fetofetal transfusion syndrome.

In a review of 90 twin pregnancies monitored by antenatal cardiotocography there were 8 cases of subsequently proven fetofetal transfusion syndrome. In 2 of these evidence of severe fetal stress had indicated immediate delivery; the 4 babies survived in circumstances that were perilous. In 1 case there was no evidence of critical fetal reserve but the recipient twin died, this probably representing an acute fetofetal transfusion during labour. In the 5 milder cases with no evidence of stress on cardiotocography, all babies survived and they required minimal or no treatment for problems relating to the fetofetal transfusion. In multiple pregnancy the cardiotocograph offers the additional bonus of detection of fetal compromise due to fetofetal transfusion.

Adult↗

PubMed1987

Antepartum cardiotocography--an audit.

Between 1981 and 1986, 9,840 women were monitored by antepartum nonstressed cardiotocography (CTG). A satisfactory fetal reserve pattern was detected in 91%, a reduced reserve pattern in 8% and a critical reserve pattern in 1%. The incidences of fetal growth retardation, Apgar score less than 6 at 1 minute, perinatal mortality and Caesarean section all increased significantly (p less than 0.001) as the degree of cardiotocographic fetal reserve worsened. Intrauterine growth retardation and/or low urinary oestriol excretion was associated with a highly significantly increased incidence of abnormal CTG traces (14.2%, p less than 0.001). A satisfactory fetal reserve pattern on cardiotocography was a reliable predictor of fetal well-being, since after exclusion of lethal malformations, the perinatal mortality rate in those patients monitored within 7 days of delivery was 3/1,000.

Cesarean Section↗

PubMedDate not supplied

[Significance of cardiotocography and amnioscopy in establishing indications for cesarean section].

In the period of 2 years (1974-1975), out of 11,672 deliveries, 398 (3.41%) were induced by cesarean section. An important role in inducing labour surgically was played by cardiotocography and amnioscopy (in addition to other methods), i.e. in 84.22% (366 cases). At present it appears necessary to use cardiotocography and aminiscopy both in the last trimester and during the labour itself, so as to facilitate the estimation of the degree of a possible danger for the foetus.

Cesarean Section↗

PubMed2003

Dynamic free-hand three-dimensional fetal echocardiography gated by cardiotocography.

OBJECTIVE: To evaluate the clinical feasibility of conventional cardiotocography (CTG) as a cardiac cycle triggering signal for three-dimensional (3D) fetal echocardiography. METHOD: Free-hand 3D echocardiography was performed on a total of 25 fetuses with and without congenital heart disease at various gestational ages (mean, 29 weeks; range, 19-35 weeks). Simultaneously, online CTG was used for time gating. Gray-scale and color Doppler dynamic 3D displays, as well as multiplanar views, were assessed for their ability to depict the cardiac morphology and correct cardiac gating. RESULTS: Valid CTG-based trigger signals could be obtained in 24 of the 25 fetuses. Correct cardiac gating was achieved in 101 of the 111 (91%) 3D datasets. Color Doppler imaging of blood flow in four dimensions was possible in 34 of 36 (94%) datasets. Reconstructed 3D and multiplanar views provided additional views not available in two-dimensional (2D) imaging. Acoustic interference between the CTG transducer and echotransducer could be reduced by the use of a high-frequency echotransducer, second-harmonic frequency imaging and appropriate positioning of the two transducers. Imaging quality was highly dependent on the quality of 2D images and random motion artifacts. CONCLUSIONS: CTG can be used as an online gating source for dynamic 3D fetal echocardiography.

Blood Flow Velocity↗

PubMed1993

Clinical evaluation of the fetus and neonate. Relation between intra-partum cardiotocography, Apgar score, cord blood acid-base status and neonatal morbidity.

The relation between intra-partum cardiotocography (CTG), cord blood acid-base status, Apgar score and neonatal morbidity was studied in 1228 consecutively live-born babies and in a subgroup of 200 babies (148 babies with a 1 min Apgar score < or = 8 and 52 randomly selected babies with a 1 min Apgar score > or = 9). The scores for the individual components of the 1 min Apgar score were strongly associated with each other, whereas the scores for the individual components of the 5 min Apgar score were less strongly associated. At 1 min the scores for muscle tone, reflex irritability and respiration but not the scores for heart rate and skin colour were associated with arterial and venous cord blood pH (low scores being associated with low pH). Out of the individual components of the Apgar score, heart rate and reflex irritability at 1 min were the best discriminators between "healthy or relatively healthy" and "severely ill" babies. Intrapartum CTG, total Apgar score and cord blood acid-base status were only weakly related. Venous cord blood pH was the best predictor of the 1 min Apgar score. Intra-partum CTG (silent pattern), 5 min Apgar score and venous cord blood pH were the best predictors of severe neonatal morbidity.

Acid-Base Equilibrium↗