Association Between Intrapartum Cardiotocogram
and Early Neonatal Outcomes in
a Tertiary Hospital in Thailand
Sarun Amsumang MD*,
Piyawadee Wuttikonsammakit MD*, Parinya Chamnan MD, PhD**
Affiliation :
* Department of Obstetrics and Gynecology, Sanpasitthiprasong Hospital, Ubon Ratchathani, Thailand
** Cardio-Metabolic Research Group, Department of Social Medicine, Sanpasitthiprasong Hospital,
Ubon Ratchathani, Thailand
Background : Intrapartum electronic fetal monitoring (EFM) has widely been used to monitor mothers in labor who are at
risk in clinical practice. There is little evidence to describe the association between EFM categories based on the newly
proposed National Institute of Child Health and Human Development (NICHD) 2008 criteria and neonatal outcomes.
Objective : To investigate the association between intrapartum cardiotocogram categories based on the NICHD 2008 and
early neonatal outcomes.
Material and Method: Intrapartum EFM tracings of 120 singleton pregnant women of equal or more than week gestation
were evaluated according to NICHD 2008 guidelines. Neonatal outcomes included Apgar scores at 1 and 5 minutes,
umbilical cord blood pH, and neonatal intensive care unit (NICU) admission. The association between EFM and neonatal
outcomes was analyzed using logistic regression.
Results : Among the 120 mothers, 83 (69.2%) had EFM tracings classified as Category I and 37 (30.8%) as Category II.
Compared to EFM Category I, Category II had a 5-fold higher risk of having 1-minute Apgar score of <9 (adjusted odds ratio
(OR) 4.96, 95% CI 1.03 to 24.00, p = 0.046) and 38-folds higher risk of having neonatal acidosis (adjusted OR 37.88, 7.33
to 195.90, p<0.001). Variable deceleration was associated with a 6-fold increased risk of having 1-minute Apgar score of
<9 (OR 6.26, 1.23 to 31.80, p = 0.027). The presence of minimal variability and variable deceleration increased the risk
of having neonatal acidosis by 16 and 8 times (OR 15.89, 3.42 to 73.80, p<0.001 and 7.84, 1.45 to 42.48, p = 0.017,
respectively).
Conclusion : EFM category II according to NICHD 2008 classification was associated with higher risk of having low Apgar
score at 1 minute and neonatal acidosis than EFM category I.
Keywords : Electronic fetal monitoring, Early neonatal outcome, Intrapartum cardiotocogram, Neonatal acidosis
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