Admission Cardiotocography as a Predictor of Low Apgar Score: An Observational, Cross-Sectional Study

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Abstract
Background and objective Cardiotocography (CTG) has been used more frequently in recent decades to reduce intrapartum fetal mortality rates. The purpose of this study was to determine whether pathological or non-reactive CTG could predict a low Apgar (Appearance, Pulse, Grimace, Activity, and Respiration) score. An abnormal trace would indicate a distressed fetus, whereas a normal trace would indicate a well-oxygenated fetus. Methods This study included a total of 470 women with a gestational period of more than 37 weeks. Based on the results of their CTGs, they were divided into three groups. An emergency cesarean section (CS) was performed if there was any sign of fetal distress on CTG. The Apgar scoring for newborns was recorded in the proforma following delivery. Results The study was carried out at two major tertiary-care hospitals in Pakistan. A reactive CTG was found in more than one-third (39.36%) of the 470 patients. An Apgar score above 8 was obtained by 34.26% of the newborns, while an Apgar score below 8 was obtained by more than half (63.40%). Only 2.34% of newborns had an Apgar score below 6. A third (30.64%) of the patients had grade-1 meconium-stained liquor (MSL), 24.89% had grade-2 MSL, 19.79% had grade-3 MSL, and 24.68% had no MSL. One-third (32.34%) of the neonates were admitted to the neonatal intensive care unit (NICU) shortly after birth. When CTG was pathological or non-reactive, the odds of securing a higher Apgar score decreased by 70.45% (OR: 0.30; 95% CI: 0.20-0.44; p<0.001). Conclusion The main conclusion drawn from this study's findings is that a pathological CTG is an indicator of a low Apgar score.

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