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Correlation of electronic-fetal monitoring with neonatal outcome in a tertiary care hospital

Author: 
Dr. Gaurav Mukhija, Dr. Yashika Bhatia and Dr. Sunil Chawla
Subject Area: 
Health Sciences
Abstract: 

Background: Fetal monitoring during labour has been known as the most important tool in clinical practice. The stress of uterine contractions may affect the fetus adversely especially if the fetus is already compromised. Even a fetus which is apparently normal in the antenatal period may develop distress during labour. Hence fetal monitoring during antepartum and intrapartum periods is of vital importance for timely detection of fetal distress so that appropriate management may be offered. . EFM is defined as use of electronic monitoring of the fetal heart to ensure well being of the fetus during labour Methods: This study is a prospective observational study of 100 patients presenting to antenatal OPD and to Labour room at >34 weeks period of gestation and was performed over a period of two years . Delivery conducted was either by vaginal route, instrumental or by caesarean section depending upon the foetal heart rate tracings and their interpretations as per the case. At the time of delivery umbilical cord blood was taken for the ph analysis. All new born babies were seen by the paeditrician immediately after the delivery and 1 and 5 minute Apgar score assessed for the delivered baby. Babies having low Apgar score or any other complication as per Pediatricians advice were admitted in NICU. The various EFM Patterns obtained were compared with the neonatal status at birth using the parameters already mentioned. The false positives and false negatives if any were tabulated. Data so obtained was analyzed statistically thereafter. Statistical Package for Social Sciences (SPSS) Version 13.0 was used for the purpose of analysis. Results: Results revealed that among the 50 subjects of the case group, 03 subjects showed the absence of the beat to beat variability, 24 subjects showed early deceleration, 07 subjects showed late deceleration, and 20 subjects showed the presence of variable deceleration. There is a significant association between absent beat to beat variability and mode of delivery and low Ph. In parturients showing early deceleration the incidence of low pH was significantly higher whereas there is no association with remaining parameters. Variable and late deceleration showed a significant association with all the parameters. Conclusions: EFM should be used judiciously. Cardiotocography machines are certainly required in the labour room. Equally important is the proper interpretation of the CTG tracings so that unjustified caesarean sections can be minimized, at the same time picking up cases of fetal distress in time which is likely to improve fetal outcome.

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