TO STUDY THE CATEGORY II CARDIOTOCOGRAPHY AND ITS CORRELATION WITH UMBILICAL CORD pH

no accelerations on fetal and 36% had decelerations (16% late decelerations and 20% variable decelerations). Our study is in concordance with study by Abbasalizadeh et al 2015 5 , who reported 2.4 % patients with tachycardia, 28% patients with late decelerations, finding of his study were in accordance to our study with 5% with tachycardia on CTG and 20% patients with variable decelerations. The findings of our study are alsi in accordance with study by Ray C et al (2017) 6


ISSN: 2320-5407
Int. J. Adv. Res. 8 (10), 1086-1091 1087 Introduction:-Fetal hypoxia can be described as reduced oxygen supply to fetus. This is usually associated with a prolonged drop in oxygen levels and an increase in carbon dioxide level in the fetal blood. Fetal hypoxia or intrauterine asphyxia is a common cause of long term neurological dysfunction and can also lead to death 1 . William Obstetrics quotes that fetal heart tracing with reduced variability is the most reliable indicator of fetal compromise 2 . Fetal compromise is manifested as fetal hypoxia. Normal FHR pattern indicates reassuring fetus, an abnormal FHR pattern may or may not equate with hypoxia. Non-reassuring fetal heart rate patterns are found in 15% of labours 2 .
The American College of Obstetricians and Gynaecologists (ACOG), has developed a three tier classification for interpreting CTG 3  Umbilical cord arterial blood provides important information about the foetuses exposed to intrapartum hypoxic event and can distinguish the infant at high risk and relates sequelae.Normal range of umbilical cord blood pH is 7.4+/-0.20 [4] . Fetal acidosis is defined as the measurement of umbilical art ery blood pH <7.2 and base deficit>12mMol/l. 4 Fetal hypoxia and metabolic acidosis are often associated with baseline bradycardia, reduced baseline variability and FHR decelerations. Baseline tachycardia is an early sign of fetal hypoxia. Though bradycardia is indicative of fetal distress, it is a late sign of fetal hypoxia. The aim of my study is to study in the fetal heart rate patterns observed in Category II CTG and its correlation with umbilical cord pH.

Material And Methods:-
The study is a prospective study, carried out in the Department of obstetrics and gynaecology, Shri Ram Murti Smarak Institue of Medical Sciences, a tertiary Care centre in Bareilly.
The study group consists of total of 100 women with category II CTG according to NICHD classification (ACOG 2013) attending labour room of obstetrics and gynaecology department were selected. On admission, after obtaining consent from the patients, all patients underwent general, systemic and obstetric examination. Electronic fetal monitoring was performed using a cardiotocograph with transducers attached for detecting fetal heart as well as uterine activity. The "Philips series 50 A, Series 50 IP-2" CTG machine was used in this study for intrapartum monitoring.
Immediately at birth, before delivery of placenta umbilical cord was clamped at 2 points, 10cm apart, with kochers clamp and cut. The umblical artery was identified in the cord and 2-3 ml of blood was withdrawn with pre heparanised syringe and was delivered to the laboratory within 5 minutes. Cord blood was analysed by radiometer ABL 800 Basic machine used in our institute. The umbilical cord arterial blood pH was used for assessing fetal acidosis. An umbilical artery pH of ≤7.20 is identified as fetal acidosis.

Statistical Analysis:
Descriptive statistics was analyzed with SPSS version 17. 0 software. Nominal categorical data between the groups were compared using Chi-squared test or Fishers exact test as appropriate P value < 0.05 was considered statistically significant.

Results:-
Results of fetal heart rate pattern in CTG were studied along with the cord blood pH and results were correlated with the perinatal outcome in terms of NICU admission.

Discussion:-
Fetal surveillance is recommended in all pregnancies for evaluation of fetal well being. Intrapartum fetal surveillance reduces the incidence of intrapartum fetal asphyxia. It has been recognized that during labour the fetus is subjected to stress which can result in fetal jeoparady.
On performing intrapartum CTG, it was found that 10% patients had baseline bradycardia, 5% had baseline tachycardia and 30% had abnormal beat to beat variability. Of the patients who had abnormal beat to beat variability,11% had absent variability without any decelerations , 19% had reduced variability of < 5 bpm, 19% had 1090 no accelerations on fetal stimulation and 36% had decelerations (16% late decelerations and 20% variable decelerations). Our study is in concordance with study by Abbasalizadeh et al 2015 5 , who reported 2.4 % patients with tachycardia, 28% patients with late decelerations, finding of his study were in accordance to our study with 5% with tachycardia on CTG and 20% patients with variable decelerations. The findings of our study are alsi in accordance with study by Ray C et al (2017) 6 .
In our study, it was observed that bradycardia was the most common pattern on CTG associated with fetal acidosis with significant p value ( 0.002) followed by tachycardia( p value 0.003) and absent variability ( p value 0.006). Our inference was in concordance with Williams K etal 2016 7 , who observed on 488 term foetuses and suggested absent variability on CTG tracing as most significant parameter associated with fetal acidosis.
It was observed that out of 100 patients with category II CTG, only 22% neonates were found to have fetal acidosis that is umbilical cord pH ≤ 7. The present study depicts revealed that umbilical cord blood pH is the best indicator of fetal hypoxia during labour. Out of 22 patients with pH ≤ 7.2, all these patient's babies were admitted in NICU, thus depicting positive correlation between fetal acidosis and subsequent need for NICU admission. The results was similar to study by Kumar N etal(2016) 12 who studied association of umbilical cord pH and fetal distress, in which out of 10 patients with pH ≤7.2 , only 6 were admitted in NICU.
In our study it was inferred that CTG pattern most significantly associated with NICU admission was bradycardia (p value-0.001), absent variability(p value-0.003) and late decelerations (p value-0.036).The results of our study was in accordance with study by Ray et al (2017) 6 , who observed that bradycardia and variable decelerations had the highest risk of NICU admission.

Conclusion:-
From the findings of our study it can be concluded that category II CTG is a good predictor of intrapartum fetal hypoxia and in presence of category II CTG, 22% patients had fetal acidosis. Category II CTG results in increased rate of caesarean section. But, it was observed that all caesarean sections done for fetal distress did not have fetal acidosis in real, as only 27.5% were seen to have umbilical cord blood pH<7.2.
There is high risk of fetal acidosis with category II CTG findings suggestive of Late decelerations, baseline bradycardia, absent variability and fetal tachycardia. High rate of NICU admission was observed in patients with bradycardia and absent variability. Therefore, Category II CTG should be evaluated promptly by clinician to prevent fetal hypoxia.
Category II CTG predicts fetal well being , but can cause undue increase in caesarean section rate, combining it with fetal scalp blood sampling, if available, can reduce the caesarean section rates and improve perinatal outcome significantly. However this is a small study and large randomized control trials are required.