Razia Kousar, Sanam Asif, Amina Saleem.
Fetal outcome in term of apgar score with typical variable deceleration on cardiotocography.
Pak J Med Health Sci Jan ;13(4):824-6.

Background: By the earlier 19 th century, it was recognized that fetal heart rate (FRH) altered in response to external and internal stresses. Cardiotocography (CTG) was introduced in 1968 and the aim was to better recognize fetus affected during delivery by hypoxia. In obstetrics cardiotocography, a technical term is “graphy’ for recording ‘cardio’ means fetal heart beat and ‘toco’ for uterine contraction during child birth. Use of this machine during the third trimester to monitor wellbeing is called non stress test (NST), and use of this machine during labor is called stress test. As a rule, low risk women intermittent auscultation for assessment for fetal wellbeing in labor should be done with pinard stethoscope. Continuous monitoring with CTG, is reserved for high risk cases, though it is not diagnostic test, due high sensitivity and low specificity. Normal cardiotocography gives sound reassurance that fetus is well at the time of recording but abnormal cardiotocography may or may not represent fetal compromise as can happen with typical variable deceleration on cardiotocography. Typical variable deceleration on cardiotocography are commonly seen when there is any form of umbilical cord entanglement and if they are persistent (atypical), they can cause fetal hypoxia. Interobserver difference exists in explaining the abnormal CTG reading. So non reassuring CTG, must be supplemented by fetal scalp blood sampling to check fetal blood gas analysis, so operative intervention and caesarean section can be planned accordingly. This study will help to conclude, that CTG is a valuable method of monitoring and assessing fetal well being in labor. Simple or typical variable deceleration was not consistently shown to be shown to be associated with poor neonatal outcome. Aim : To determine fetal outcome in patient with typical variable deceleration on cardiotocography during labor. Method: It was descriptive case series conducted at Obstetrics and Gynaecology Department, Social Security Hospital, Multan Chungi, Lahore. The calculated sample size is 145 cases with 4% margin of error, 95% confidence interval, taking expected percentage of APGAR score, > 7 in typical variable deceleration. Results: Total 145 cases were included in study. These patients have typical variable deceleration during labor. Out of these 109 cases, 75.2% were having good fetal outcome while 24.8% having poor fetal outcome. Conclusion: Typical variable deceleration on cardiotocography is not always associated with poor fetal outcome. So it demands further diagnostic modalities before undertaking operative interventions.

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