TEMPLATE DESIGN © Does Pathological CTG Related to Abnormal Umbilical Cord Blood pH? Dr. Rima Anggrena Dasrilsyah, Dr. Haslina Sarkawi, Dr. Krishna Kumar Hari Krishnan Department of Obstetric and Gynaecology, Hospital Tuanku Jaafar Seremban, Negeri Sembilan OBJECTIVES 1.To identify the correlation between pathological CTG and umbilical cord blood pH in determining neonatal acidosis. METHODS This retrospective study was conducted from November 2011 to April 2012 at labour room Hospital Tuanku Jaafar Seremban. 110 of patient with singleton, term pregnancy, fetus in cephalic presentation, absence of known fetal malformation who underwent caesarian section with indication of fetal distress were recruited. Either external or internal cardiotocography (CTG) was used to record the FHR and tocodynamometry was used to monitor the contraction. The CTG tracing interpretation are dependent on the staff in charge. CTG were classified as early deceleration if uniform, repetitive, periodic slowing of FHR with onset early in the contraction and return to baseline at the end of the contraction. Late deceleration is defined as uniform, repetitive, periodic slowing of FHR with onset mid to end of the contraction and nadir more than 20 seconds after the peak of the contraction and ending after the contraction. Variable deceleration is when variable, intermittent periodic slowing of FHR with rapid onset and recovery. Time relationships with contraction cycle are variable and they may occur in isolation. Sometimes they resemble other types of deceleration patterns in timing and shape. Lastly, prolonged deceleration (bradycardia) if an abrupt decrease in FHR to levels below the baseline that lasts at least 60–90 seconds. These decelerations become pathological if they cross two contractions, i.e. greater than 3 minutes. The umbilical blood gas analysis was performed by collecting blood sample from umbilical artery and vein by a heparinized 1 ml syringe in a double clamped segment of the umbilical cord immediately after delivery of the baby and before delivery of placenta. The sample will be kept in icepacks and would be processed within 30 minutes of collection. In general the lower range for normal arterial pH is at least 7.10 and for venous pH is 7.2 (Chan and To, 2009) RESULTS & DISCUSSION The results of the studies is as shown by the table below: CONCLUSIONS REFERENCES This study shows pathological CTG does not completely correlate with abnormal cord blood pH and neonatal acidosis. However the number of samples is relatively small and thus future study with larger number of samples should be done to ensure the reliability of study result. OPTIONAL LOGO HERE 1.Hacker NF, Gambone JC, Hobel CJ (2010) Essential of Obstetrics and gynecology. 5 th Edition Saunders Elsevier. 2.James LS (1958) The acid-base status of human infants in relation to birth asphyxia and onset of respiration. J Paediatr. 3.Chan, SC. and To, WK. (2009) Correlation Between Intrapartum Cardiotocogram Findings and Cord Blood pH in Term and Preterm Labours. HKJGOM, 9 (01), pp. 36­42 4.Anchesci MM, Piazze JJ, Vozzi G, Berretta AR, Figliolini C, Vigna R and Cosmi, EV. (1999) Antepartum Computerized CTG and neonatal acid-base status at birth. International Jounal of Gynaecology and Obstetric, 65, pp. 267­272 5.Costa A, Santos C, Ayres-de-Campos D, Costa C and Bernardes J. (2010) Access to computerized analysis of intrapartum cardiotocographs improves clinicians prediction of newborn umbilical artery blood pH. BJOG, 45, pp. 1288­1293 INTRODUCTION Fetal surveillance during labour is an essential element of good obstetric care. Electronic fetal monitoring during labour are developed to detect Fetal Heart Rate (FHR) pattern that were frequently associated with delivery of infants in a depressed condition. Early recognition of changes in heart rate pattern that may be associated with fetal hypoxia and umbilical cord compression would enable physician to intervene and prevent poor neonatal outcome (Hacker et al., 2010) To evaluate neonatal outcome, fetal acid-based status is currently the most reliable indication of asphyxia or acidosis (James, 1958). The umbilical vessel is easily accessible to investigate fetal oxygenation after delivery. However, there is a concern on the reliability of abnormal fetal heart tracing and the implication to abnormalities of cord blood pH. Thus this study is to compare the correlation between these two parameters. According to the study, most of samples had normal umbilical cord blood pH despite of abnormal FHR tracing pattern. Majority of the normal pH samples is from early deceleration and prolonged deceleration contribute to the biggest percentage in abnormal pH pool. In this study, it has been found that intra partum CTG and cord blood pH were rather poorly related. Another study also shows that a lower incidents of metabolic acidosis, despite a much higher incidents of pathological CTG patterns, suggest that abnormal CTG findings tend to be less specific (Chan and To, 2009). In regards of type of sample being collected, most studies preferred umbilical arterial sample than venous, as this will provide acid base status of fetal blood returning to placenta. However the pH difference should be small with a minimal venous- arterial pH difference of 0.02, thus the cord blood sample was not routinely checked (Chan and To, 2009).