Assessment of Neonatal Outcomes in Relation to Non-Reassuring CTG during Labor

Abstract

 Objective: To assess the association of specific non-reassuring intrapartum cardiotocography (CTG) features with early neonatal outcomes, particularly low 5-minute Apgar score and neonatal intensive care unit (NICU) admission.

Study design and setting: Descriptive longitudinal study conducted in the Department of Obstetrics and Gynaecology, Dow University Hospital, Karachi.

Methodology: A total of 188 women with singleton term pregnancies and non-reassuring intrapartum CTG were enrolled by non-probability consecutive sampling. CTG features were classified using a standardized operational framework, and maternal, obstetric and neonatal outcomes were recorded. Associations with low 5-minute Apgar score and NICU admission were examined using bivariate analyses. The reported multivariable logistic regression models were treated as exploratory because the available records did not document the original model-building diagnostics in sufficient detail.

Results: Mean maternal age was 28.4 ± 5.2 years and mean gestational age at delivery was 38.6 ± 1.1 weeks. Cesarean delivery occurred in 104 (55.3%) women. Reduced baseline variability was present in 82 (43.6%) tracings and late decelerations in 51 (27.1%). Mean Apgar score increased from 6.6 ± 1.5 at 1 minute to 8.1 ± 1.2 at 5 minutes. Low 5-minute Apgar score occurred in 34 (18.1%) neonates and 50 (26.6%) were admitted to the NICU. Reduced baseline variability and late decelerations were significantly associated with both adverse outcomes.

Conclusion: Reduced baseline variability and late decelerations were associated with adverse early neonatal outcomes, including low 5-minute Apgar score and NICU admission. These observational findings support careful CTG interpretation but do not establish that CTG-directed intervention itself improves neonatal outcomes