Intra Operative Findings and Fetal Outcome in Primigravidae Taken for Caesarian Section on the Basis of Non-Reassuring Cardiotopographic Traces

Khayrul Nisa, Syed Masuma Rizvi

Abstract: Background: An important function of cardiotocography (CTG) is to promptly identify non-reassuring fetal status during delivery, as these deviations often prompt primigravidae to undergo a caesarean section. However, these abnormal CTG traces may or may not correspond to intraoperative findings such as meconium-stained liquor or low APGAR scores at birth. It's worth noting that not all abnormal CTG changes result in poor outcomes. Therefore, there is a pressing need for research to explore their correlation, demonstrating the benefits of CTG in accurately detecting non-reassuring fetal status and how it correlates with subsequent intraoperative findings. Aim: To demonstrate the correlation of intra operative findings and fetal outcome in primigravida undergoing caesarean section for non reassuring cardiotocography. Methods: A prospective study of 50 cases of primigravida undergoing emergency caesarean section for non reassuring CTG was taken at the department of Obstetrics and Gynaecology Lalla Ded hospital Srinagar was taken. Their CTG traces were correlated with their intraoperative findings such as meconium stained liquor, cord around neck, oligohydramnios, placental abruption and apgar score at birth. Results: Out of these 50 primigravida who underwent emergency caesarean section,62% had CTG with decelerations-Non reactive, 30% had a CTG trace with persistent decreased variability while 8% had a persistent low baseline on CTG . Among patients with CTG trace showing decelerations 58% had meconium stained liquor, 16.5% had cord around the neck and 25.8 % had low APGAR scores at birth . Among the group of patients with decreased variability 42.1% had meconium stained liquor, 10.5% had cord around the neck and 21% had low APGAR scores at birth. Among the group with low baseline, 51% had meconium stained liquor, 23% had cord around neck and 39 % had low birth apgar. Conclusion: Cardiotocography shows a positive correlation with meconium-stained liquor and APGAR scores at birth, but not with cord entanglements. Therefore, it's crucial to use CTG judiciously and consider employing other non-invasive, cost-effective tests to detect non-reassuring fetal status, aiming to reduce unnecessary caesarean sections.

Keywords: Primigravida, Intraoperative findings Neonatal outcome, Electronic fetal monitoring, perinatal outcome, CTG