Imperial Journal of Interdisciplinary Research (IJIR)X

Vol-3, Issue-7, 2017

ISSN: 2454-1362, http://www.onlinejournal.in

PredictiveValueofCTGinPostDatedPregnancy

1 1 2 3 3
AquisaBashir ,FarahNabi ,AsifaAli ,IrfanGul ,ParveezShah
1
RegistrarGynaecologyAndObstetricsSkimsMedicalCollege,Bemina,Srinagar
2 3
RegistrarGynaecologyAndObstetrics,LalDedHospitalGMC,Srinagar Registrar
Medicine,GovernmentMedicalCollege,Srinagar

Abstract:ourstudyevaluatestheeffectivenessof
intrapartumcardiotocographyinpatientswith
postdatedpregnancycomparedtointermittent
auscultation.
MaterialsAndMethods;Ourstudywas
conductedatskimsmedicalcollageBemina
Srinagaramong100patientswereincludedin
studyafterfulfillinginclusionandexclusion
criteriawithpregnanciesbeyondEDDandwith
nootherriskfactorswereincludedinthestudy;
patientsweredividedintotwogroups,50
patientswhounderwentCTGonadmissioninto
labourwardformedthestudygroupand50
patientswhounderwentintermittentauscultation
formedthecontrolgroup.Antenatalfoetal
monitoringnamelydailyfoetalmovementcount,
twiceweeklynonstresstestwithamnioticfluid
assessmentandDopplervelocimetryusing
ultrasoundweredoneinallpatientsuntilthe
onsetoflabour.Labourwasinducedwhenever
NSTwasnonreassuringorultrasoundshowed
oligohydramnios.Partogramwasusedtomonitor
thecourseoflabour.
Results:Thefoetaloutcomewasbetterinthe
studygroupthaninthecontrolgroupwithfewer
depressedbabies.Cardiotocographyhada
positivepredictivevalueof34.06%anda
negativepredictivevalueof93.67%withaP
valueof0.010.Conclusion:Cardiotocographyis
definitelysuperiortointermittentauscultationin
intrapartumfoetalmonitoring.Despitethehigh
numberoffalsepositives,CTGpredictsthe
outcomeoflabourineverypatientandespecially
incaseswithprolongedpregnancyitservesasa
valuablescreeningtooltopickupthosecases
thatmaybecompromisedbytheeventsoflabour.
Keywords:Cardiotocography(CTG),NonStress
Test(NST),ProlongedPregnancy,FoetalHeart
Rate(FHR),Beats/Minute(bpm).
INTRODUCTION
Thegoalofobstetricsisapregnancythat
culminatesinahealthyinfantandminimally
traumatizedmother.Thedurationofpregnancyis
40weeks(280)dayscalculatedfromtheLast
MenstrualPeriod(LMP),accordingtoNaegeles
rule.Only4%(1in20)ofwomendeliveronthe
duedate(EDD).Posttermpregnancyisdefined 1114weeksofgestation.MATERIALSAND
aspregnancyatorbeyond41+3weeksof METHODSThisisaprospectivestudytoassess
gestation,i.e.10daysafterEDD.Althoughterm thepredictivevalueofcardiotocographyin
pregnancyis intrapartumfoetalsurveillanceofpostdated
pregnancy.Thestudywasconductedin.skims
medicalcollegebeminaSrinagar.Thepopulation
consistsofpregnantpatientswithregular
between3742weeksofgestation,thereis
menstrualcyclesanddatingscandoneat1114
increasedmaternalandfoetaljeopardyafterthe
weeksofgestation.Allhighriskfactorsnamely
expecteddateofconfinement,therebycausing
previouscaesareansection,recurrent
considerableanxietytothemotherandthetreating
miscarriages,maternalagemorethan35years,
obstetrician.Inductionoflabourcomparedto
twinpregnancy;medicalcomplicationsnamely
expectantmanagementisassociatedwithfewer
pregnancyinducedhypertension,gestational
perinataldeathsandcaesareansectionsinpost
diabetes,epilepsy,heartdisease,asthma,
termpregnantpatients.(1,2)Themanagementof
intrauterinegrowthrestrictionandcongenital
pregnancybeyondEDDreliesonanaccurate
anomaliescomplicatingpregnancywereexcluded
assessmentofthegestationalage,calculatedfrom
fromthestudy.Majorityofthepatientswere
theLastMenstrualPeriod(LMP)assuming
bookedatskimsHospitalfromearlygestation..
normal28dayscycle(Naegelesformula).Dating
Theagegroupofpatientsvariesbetween18and
gestationalagewithLMPaloneassumesboth
34inbothgroups.Itwasnoticedthatpatients
accuraterecallbythepatientandovulationonthe
whowereobeseattermhadahigherincidenceof
14thdayoftoallwomen,i.e.datingscanisa
prolongedpregnancyandcaesareansectionrate
moreaccurateassessmentofgestationalagethan
andearlyinductionoflabourispreferredinsuch
lastmenstrualperiodwithfewerpregnanciespast
patients.(5)Thestudygroup(50)consistsofthose
40weeksofgestation(3)Itisusefultodetermine
patientswithpregnanciesbeyondEDDwho
CrownRumpLength(CRL)of4584mmorhead
underwentcardiotocographyonadmissioninto
circumferenceifCRLisgreaterthan84mmin
labourwardandthecontrolgroup(50)consistsof
datingscan.(4)themenstrualcycle.Performing
thosepatientswithpostdated
routinefirsttrimesterultrasonographybetween

Imperial Journal of Interdisciplinary Research (IJIR) PAGE 480X

 Imperial Journal of Interdisciplinary Research
(IJIR) Vol-3, Issue-7, 2017X

ISSN: 2454-1362, http://www.onlinejournal.in

wasnolongerusedasit
tendstooverdiagnose
pregnancieswho oligohydramnios.(8.9)
underwentintermittent
auscultationon
admissionintolabour
ward.Antenatalfetal Thereare3featuresin
monitoringnamely CTG
dailyfetalmovement
count,biweeklynon
stresstestingwith BaselineHeartRate
amnioticfluid (bpm).
assessmentandDoppler
velocimetryby
ultrasoundweredonein
allpatientstilltheonset BaselineVariability
oflabour.Methodsused (bpm).
forcervicalripening
andinductionoflabour
weresweepingof
Decelerations.
membranes,vaginal
Misoprost(PGE1)and
dinoprostonegel.
Thereare3CTGPatterns

Mechanicalmethodsfor
cervicalripeninghas Normal/reassuringFHR
fewerincidencesof 100160bpm:
uterine variability 5: None or
hyperstimulationand early decelerations.
changesinfoetalheart
ratecomparedto
prostaglandins.(6,7)
Nonreassuring
Syntocinonand
FHR161180bpm:
amniotomywereused
foraccelerationof variability<5for3090
labour.Labourwas minutes:variable
inducedwheneverNST decelerations 60 bpm
wasnonreassuringor lasting for 60 seconds
amnioticfluid or
assessment(Single
verticalpocket<2cm)
byultrasoundindicates
present>90minutesand
oligohydramnios.
occurringwith>50%of
Manningsbiophysical
contractionsorvariable
scoreofmeasuringfour
decelerations<60bpm
quadrantamnioticfluid
and>60secondsor
indicesbyultrasound
presentforupto30 reassuringfeaturesand
minutesandoccurring indicatesurgent
with>50%of interventionduetofoetal
contractionsorlate acidosis.ssificationof
decelerationspresent CTGNICEguidelines
forupto30minutes December2014.(3)
andoccurringwithover
50%ofcontractions.

RESULTSAND
DISCUSSION
3.AbnormalFHR
>180or<100bpm:
variability<5for>90
minutes:Non Inourstudytherewere
reassuringvariable 100patientswithage
decelerationsstill distributionasshownin
observed30minutes table1withhighest
afterstarting percentageinagegroup
conservativemeasures of26t032whichis
andoccurringwithover commonreproductive
50%ofcontractionsor agegroupinkashimiri
latedecelerations population
presentforover30
minutesthatdoesnot
improvewith Age
conservativemeasures number
andoccurringwithover Percentage
50%ofcontractionsor 1825
bradycardiaorasingle 20
prolongeddeceleration 20%
lasting3minutesor 2632
more. 55
55%
32
InterpretationofCTG 25
Traces 25%
Table1showingage
distributionofpatients

Normal/reassuringall3
featuresare
normal/reassuring. Inourstudy50patients
wereincludedingroupA
whichiscasesgroupin
whichmonitoringwas
Nonreassuring1non donewithcardio
reassuringfeatureand2 topography(CTG)and
normalfeaturesand groupBcomprisedof
suggestsneedfor controlgroupinwhich
conservativemeasures. monitoringwasdoneby
intermittentauscultation.
ingroupA26Patients
werepostdatedby35
Abnormal1abnormal
days,14patientsby58
featureor2non
daysand10patientsby8
10daysasintable2 patternwasnotedwhich
.IngroupB30patients wasnormal30patients
werepostdatedby35 nonreassuringin10
days,12patientby58 patientsandabnormalin
days,8patientsby8 10patients.Whichis
10. furtherexplainedintable
3

CTG
TABLE2Durationof No
Prolongation(Post of
E.D.D) Percentage
Pattern
patients
Days
Group
A
GroupBpatients Normal(30)
PostDated Labour
patients

66.6%
Intermittent

Natural20
CTGGroup

33.3%
auscultation

Caesarean

35days section10
26

30
58days Non
14 Labour

12 40%
810days reassuring(10)
10 Natural4

8 60%

InourstudyCTG Caesarean
monitoringwasdoneon
groupAandCTG
 90%

section6
Caesarean

Abnormal(10)
Labour

section9
10%

Natural1

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(IJIR) PAGE 481X
 Imperial Journal of Interdisciplinary Research
(IJIR) Vol-3, Issue-7, 2017X

ISSN: 2454-1362, http://www.onlinejournal.in

wasnonreassuringor
amnioticfluid
assessment(Single
verticalpocketof<2
Inthestudy cm)showed
population,allpatients oligohydramnios.
whohada

Onadmissioninto
normaltestpatternand labourward,30patients
whodeliverednormally withaNormal CTG
showed poor foetal patternwereallowedto
outcome (APGAR 6
continuein labour;20
in 1
patientsdelivered
normallyand10by
caesareansection.
min),whereasinthe Therewere2depressed
controlgroupatotalof babiesinpatientswho
8patientsshowedpoor hadnormalCTG
foetaloutcomebecause patterndespitemodeof
ofmeconiumstaining delivery.However,both
ofamnioticfluid. thebabiesrecovered
followingobservation
inthenewbornward
for3days.This
Outof100patients,50 explainsthefactthat
patientswhobelonged thosefoetuseswho
tothestudygroup maintainjustenough
underwentCTGon oxygenationpriortothe
admissionintolabour onsetoflabourin
ward.Thesepatients prolongedpregnancy
hadregularmenstrual showevidenceoffoetal
cyclesandhadadating comprise.
scanbetween1114
weeksofgestation.
Majorityofthese
patientswere Among10patientswho
primigravidaewithno hadanNonreassuring
riskfactors.Upon CTGpatterninthe
reachingterm,their studypopulationand
pregnancieswere wereallowedto
closelymonitoredwith continueinlabour,4
biweeklynonstress patientsdelivered
testingandamniotic normallyand6by
fluidassessmentby caesareansection.Since
ultrasoundtilltheonset thesepatientswerein
oflabour.Labourwas activelabourwithclear
inducedwheneverNST amnioticfluid,there
wasnoneedfor babiesbornafter42
intervention.There weeksofgestation
were3depressedbabies comparedtothoseborn
ofAPGAR<6in1 at40weeksof
minutefollowing gestation.11
normaldelivery.These
babiesalsorecovered
followingobservation
Inthecontrolgroup,50
for3days.
patientswithprolonged
pregnancyunderwent
onlyintermittent
Tenpatientswhose auscultationthroughout
pregnancieswere labour.Labourwas
prolongedformorethan acceleratedwith
oneweek(41+weeks) Syntocinon;28patients
hadanAbnormal CTG deliverednormallyand
patternonadmission. 22bycaesareansection.
The amnioticfluidwas Poorfoetaloutcome
scantyandmeconium wasobservedin12
stained.Labourwas patients.Thebabies
terminatedbycaesarean recoveredafter
sectionin9patientsand observationinnew
onedelivered bornward.Therewas
vaginally.Therewas1 noperinatalmortality.
depressedbabyof
APGAR<6in1minute
thatrequiredadmission
CTGisassociatedwith
innewbornwardfor5
increasedincidenceof
days.Therewasno
caesareansectionsand
perinatalmortalityin
instrumentalvaginal
thisgroup.
birthscomparedto
intermittent
auscultation.11Patients
Therefore,itcanbe whoaremonitoredwith
concludedthatwhen intermittent
pregnancyisprolonged auscultationalonemay
formorethanoneweek belosttofollowup
followingEDD,the resultinginincreased
chanceofmeconium perinatalmorbidityand
stainingwithscanty mortality.12
liquorisincreased,
therebyincreasingpoor
foetaloutcome.Foetal
Inthestudy,Admission
BloodSampling(FBS)
testCTGhadthe
maybeconsideredin
followingresults
thosepatientswithnon
reassuringorabnormal
CTGpatterntoimprove
Sensitivity54%

foetaloutcome.10The
incidenceofcerebral 82%
palsyisincreasedin
 maybeusedinpatients
withanonreassuring
34.36% CTGwhodonot
respondtoconservative
measures.10However,
FBSisinvasive,needs
93.674%
expertise,causes
maternaldiscomfort
andrequiresrepeated
procedures.10The
ultimateaimisto
CONCLUSION reducematernaland
perinatalmorbidityand
mortality.
Patientswithprolonged
pregnancycanbe
managedwiselywith ACKNOWLEDGEM
properselectionof ENT
casesand
cardiotocography
remainsthegold
standardforintrapartum IsincerelythankThe
foetalmonitoringof Management,The
patientscomparedto Dean,TheMedical
intermittent SuperintendentandThe
auscultation.Despite HeadoftheDepartment
thehighnumberoffalse ofObstetricsand
positives,CTGisavery Gynaecologyfor
usefulscreeningtoolfor permittingmetocarry
identifyingthosebabies outthisstudy.Ialso
thatarenormaland thankthepatientsfor
thosethatare theirkindcooperation.
compromisedbythe
eventsoflabour.Foetal
BloodSampling(FBS)
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ISSN: 2454-1362, http://www.onlinejournal.in

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