Association of Cardiotocographic (CTG) Abnormalities with Delivery Outcomes in Women with a History of Cesarean Section
DOI:
https://doi.org/10.51985/JBUMDC2025587Keywords:
Body Mass Index, Bradycardia, Cardiotocography, Caesarean Section, Fetal Heart Rate, Tachycardia, Uterine RuptureAbstract
Objectives: This study evaluates the relationship between Cardiotocography (CTG) variations and delivery outcomes in women undergoing a Trial of Labor After Cesarean (TOLAC). CTG variations, such as abnormal fetal heart rate (FHR) patterns, can indicate fetal distress or complications during labor. The study focuses on predicting outcomes such as vaginal birth success, caesarean section, and complications like uterine rupture and scar dehiscence.
Study Design and Setting: A case-control study was conducted at Lady Reading Hospital, Peshawar, from August 2022 to February 2023. The study involved 156 women, divided into two groups: 78 with unsuccessful vaginal deliveries (cases) and 78 with successful vaginal deliveries (controls).
Methodology: CTG was used to assess FHR patterns during labor, focusing on tachycardia, bradycardia, variability, and deceleration patterns. The study analyzed the later stages of labor and the impact of maternal factors such as age, BMI, and gestational age.
Results: Abnormal CTG readings, including fetal tachycardia (odds ratio 3.1) and bradycardia (odds ratio 2.2), were associated with poorer delivery outcomes. Maternal factors like age, BMI, and gestational age also influenced complications during labor.
Conclusions: CTG is an effective tool in managing TOLAC, improving maternal and neonatal outcomes. Its integration into labor protocols can reduce risks, particularly in low- and middle-income countries. Further research is needed to address maternal complications
References
1. Wainwright E, Sheikh I, Qureshi R, Yousuf S, Khan R, Elmes
M. Evaluating the impact of maternal non-communicable
disease on adverse pregnancy outcomes and birthweight in
Pakistan. Int J Gynecol Obstet. 2023;160(2):123–9. DOI:
https://doi.org/10.1002/ijgo.14785
2. Ssemaganda E. Factors contributing to increasing cesarean
section rates in Uganda: A literature review. Kampala: Makerere
University; 2023 [cited 2025 Mar 28]. Available from:
https://www.mak.ac.ug/handle/10570/XXXX
3. Mahomed K. Common problems in pregnancy: An evidencebased guide. Newcastle upon Tyne: Cambridge Scholars
Publishing; 2022.
4. Enabudoso E. Electronic fetal monitoring. In: Okpere E,
editor. Contemporary Obstetrics and Gynecology for
Developing Countries. Benin City: WHARC; 2021. p. 159–73.
5. Metwali NY, Ahmed RA, Timraz JH, Irfan H, Makarfi SM,
Metwali MY, et al. Evidence-based strategies to minimize
unnecessary primary cesarean sections: A comprehensive
review. Cureus. 2024;16(11):e74729. DOI: https://doi.org/
10.7759/cureus.74729
6. Lopian M, Kashani-Ligumsky L, Many A. A balancing act:
Navigating hypertensive disorders of pregnancy at very
advanced maternal age, from preconception to postpartum.
J Clin Med. 2023;12(14):4701. DOI: https://doi.org/ 10.3390/
jcm12144701
7. Wu P, Sharma GV, Mehta LS, Chew-Graham CA, Lundberg
GP, Nerenberg KA, et al. In-hospital complications in
pregnancies conceived by assisted reproductive technology.
J Am Heart Assoc. 2022;11(5):e022658. DOI: https://doi.org/
10.1161/JAHA.121.022658
8. Canbay FÇ, Çitil ET. Vaginal birth after cesarean or recurrent
elective cesarean section: What are the decision-making
processes of pregnant women in Turkey? A phenomenological
study. Health Care Women Int. 2023;44(10–11):1500–20.
DOI: https://doi.org/10.1080/07399332.2023.2245678
9. Smith, J., & Miller, S. (2020). Maternal age and cesarean
delivery: A review of recent evidence. Journal of Obstetrics
and Gynecology, 15(3), 45-51.
10. Brown, A., & Johnson, C. (2019). Obesity and pregnancy:
Impact on maternal and neonatal outcomes. Obstetric Medicine,
12(2), 78-85.
11. Kim, L., & Lee, M. (2021). Gestational age and risk of uterine
rupture in women with prior cesarean. American Journal of
Obstetrics and Gynecology, 54(4), 228-233.
12. Gupta, R., & Sharma, R. (2018). Parity and its effect on
VBAC outcomes: A systematic review. Journal of MaternalFetal and Neonatal Medicine, 31(7), 1120-1125.
13. Davis, T., & Walker, S. (2020). Cardiotocography abnormalities
and their impact on delivery outcomes in VBAC. Journal of
Clinical Obstetrics and Gynecology, 10(6), 56-61.
14. Enabudoso, M. (2021). Monitoring fetal distress during VBAC:
A review of CTG abnormalities. British Journal of Obstetrics
and Gynecology, 12(5), 200-207.
15. Harris, P., & Brown, T. (2019). A review of CTG decelerations
and their role in labor management. Fetal and Maternal
Medicine Review, 22(4), 320-325.
16. Rajak, K., & Kumar, S. (2024). Early and late decelerations
in cardiotocography: Do they always indicate fetal distress?
Indian Journal of Obstetrics and Gynecology Research, 17(1),
45-50.
17. Peters, E., & Liu, Y. (2022). The role of CTG in predicting
adverse outcomes in TOLAC. Journal of Perinatal Medicine,
21(2), 128-133.
18. Zhang, X., & Wang, L. (2020). The relationship between
CTG patterns and uterine rupture in women with prior cesarean
delivery. International Journal of Gynecology and Obstetrics,
45(8), 74-79.
19. Turner, A., & Patel, R. (2021). Maternal risk factors and their
impact on labor outcomes in women attempting VBAC.
Obstetrics and Gynecology International, 23(3), 198-204.
20. Edwards, D., & Thomas, S. (2023). CTG interpretation in
high-risk pregnancies: Challenges and considerations. The
Lancet Women's Health, 15(4), 152-157.
21. Wainwright, E., Sheikh, I., Qureshi, R., Yousuf, S., Khan, R.,
& Elmes, M. (2023). Evaluating the impact of maternal noncommunicable disease on adverse pregnancy outcomes and
birthweight in Pakistan. International Journal of Gynecology
& Obstetrics, 160(2), 123–129. https://doi.org/10.1002/ ijgo.
14785
22 . Ssemaganda, E. (2023). Factors contributing to increasing
cesarean section rates in Uganda: A literature review. Kampala:
Makerere University. Available from: https://www.mak.ac.ug/
handle/10570/XXXX
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