The Study Of The Relationship Between Abnormal Cardiotocography During The Active Phase To The Second Stage Of Labor And Pregnancy Outcome

Objective: The purpose of this study was to investigate the relationship betweenabnormal cardiotocography during the active phase to the second stage of labor andpregnancy outcome under the new three-tier categorization as a guide for themanagement of the labor.Method: This study is based on data collected between February-August2012in the first Affiliated Hospital of Fujian Medical University, vaginal trial productionand cervix3cm beginning continuous electronic fetal monitoring maternal centralclinical data of453cases were analyzed retrospectively. Based on2008NationalInstitute of Child Health and Human Development (NICHD)three-tier categorization,categoryâ… graphics193cases were proposed as a control group and category â…¡, â…¢graphics260cases as the observation group.The two groups were compared to eachother by considering pregnancy complications and pregnancy outcome in order to findout the difference by investigating the characteristics of the abnormal pattern andtiming the appearance of graphics abnormality. Data collected were analyzed by usingthe statistical software SPSS20.0to determine the normality test, chi-square test andt-test.Results: In observation group, the incidence of oligohydramnios and cordentanglement were significantly higher (P <0.05). Regarding the gestationalhypertension, gestational diabetes, premature birth, prolonged pregnancy,polyhydramnios and premature rupture of membranes, there were no statisticallysignificant difference between those two groups (P>0.05).In the observation group, â…¡or â…¢ degree of meconium stained amniotic fluid andnewborn in the NICU were statistically significant (P <0.05). Regarding neonatalasphyxia in those two groups, the difference was not statistically significant (P> 0.05).It was observed that the frequency of cesarean section and forceps delivery inthose two groups were statistically significant (P <0.05), while the difference ofnormal labor was not significant (P>0.05).Type of abnormal cardiotocography that appear in the observation group:119cases of VD (45.77%),57cases of ED with VD (21.92%),16cases of prolongeddeceleration (6.15%),16cases of VD with prolonged deceleration (6.15%),9casesof the decreased baseline FHR variability (3.46%),8cases of ED with prolongeddeceleration (3.08%),5cases of tachycardia (1.92%),5cases of VD with LD(1.92%),4cases of ED with VD, prolonged deceleration(1.54%),3cases of VD withtachycardia (1.15%),2cases of ED with VD, tachycardia (0.77%),2cases of VDwith LD, prolonged deceleration (0.77%),2case of ED with VD, tachycardia(0.77%),2cases of ED with VD, LD (0.77%),2cases of ED with LD, prolongeddeceleration (0.77%),2case of ED with LD (0.77%),2cases of LD (0.77%),1caseof the decreased baseline FHR variability with ED (0.38%),1case of the decreasedbaseline variability with LD, VD, tachycardia (0.38%),1case of VD with bradycardia(0.38%),1case of ED with VD, bradycardia (0.38%).Regarding the timing of abnormal cardiotocography, it was observed that in theobservation group it had occurred as stated:13cases of the early stage of the activephase (5.00%),5cases of the early-to-mid active phase (1.92%),38cases of themid-term of active phase (14.62%),13cases of the mid-to-late active phase(5.00%),17cases of the end of the active period(6.54%),62cases of the end of theactive phase and the second stage (23.85%),82cases of the second stage (31.54%),30cases of the active phase to the second stage (11.54%).Conclusion:(1)Abnormal cardiotocography during the active phase to the second stage oflabor is related to the oligohydramnios and cord entanglement.The most commonabnormal graphics were variable deceleration.Meconium-stained amniotic fluid alsoprompt fetal hypoxia.(2)The top three most common abnormal cardiotocography during the activephase to the second stage of labor were variable deceleration,early deceleration,prolonged deceleration.(3)Diagnostic of category â…¢ FHR tracings are more stringent,which prompt thefetus acid-base imbalance, the need for the immediate intervention had to beconsidered. Category â…¡graphics account for the majority.Its treatment requires acombination of comprehensive clinical situation and need to continue closeobservation.(4)The abnormal cardiotocography occurs mainly at the end of active phase andthe second stage.When monitoring is being done during those stages,we should payclose attention to the EFM tracings.(5)In order to reduce the false positive rate of electronic fetal heart rate monitoringand improve the clinical value, we should follow these three aspects:â‘ standardizedtrainingâ‘¡reference computer analysis systemâ‘¢monitoring with other methods offetal surveillance.