The role of admission cardiotocography in the management of high-risk pregnancies in a tertiary health facility in Nigeria

Abstract

Admission cardiotocography (CTG) on the labour ward helps to identify foetuses that cannot withstand the stress of labour and to predict intra-partum and neonatal adverse events. The aim of the study is to evaluate the role of admission CTG in detecting pre-existing foetal chronic hypoxia and in predicting labour and neonatal outcomes. This is a prospective cohort study.  A 30-minute admission CTG was performed for each of the recruited 378 participants. The CTG was interpreted, using both the FIGO 2015 guideline and the physiological interpretation. Women presenting with chronic hypoxia on CTG had caesarean section while those with suspicious or pathological CTG had intra-partum foetal resuscitation. Patients who responded well to the resuscitation proceeded with labour during which foetal heart rate was monitored with intermittent auscultation (IA). Data was analysed using a Statistical Package for Social Science (SPSS) software, version 19. Admission CTG was normal in 270 (71.43%) and abnormal in 108 (28.57%) out of the 378 patients. Compared with women who had normal admission CTG, women who had abnormal traces were more likely to have caesarean section for abnormal IA results [66 (61.11%) and 27 (10.00%) for abnormal versus normal admission CTG respectively, relative risk RR =  6.11, 95% confidence interval 4.14 to 9.01], 1 minute Apgar score less than 7 [78 (72.22%) and 9 (3.33%); RR 21.67; 95% CI 1.29 - 41.62] and 5 minutes Apgar score <7 [57 (52.78%) and 6 (2.22%); RR 24.63; 95% CI 10.94 - 55.44]. The same was true for neonatal admission to SCBU [51 (47.22%) and 24 (8.89%); RR 5.31; 95% CI 3.45 - 8.17] and early neonatal deaths (9 and 0 in the abnormal and normal CTG groups respectively). The incidence of normal and abnormal admission CTG was 71.43% and 28.57% respectively. The latter was significantly associated with poorer labour and neonatal outcomes and therefore the associated patients need close monitoring in labour.