Abnormal fetal heart tracing patterns in patients with meconium staining of amniotic fluid and its association with perinatal outcomes

Background: CTG is the most commonly used test for antepartum and intrapartum fetal surveillance. Objective: Evaluation of labours complicated by MSAF or abnormal fetal heart rate tracings or both and its predictability of adverse perinatal outcomes.Methods: Prospective observational study of laboring patients with evidence of suspected fetal distress carried out at department of Obstetrics and Gynecology, Institute of Maternal and Child Health, Kozhikode, Kerala during the time period July 2013 - December 2013. Analysis of clinical data of 600 labouring women with evidence of presumed fetal jeopardy (either in the form of abnormal FHR tracings or MSAF or both) were done. Pregnancy variables and perinatal outcomes were compared and correlated with FHR tracings. Statistical analysis was carried out by chi-square and ANOVA tests. Level of significance was set at P value <0.05.Results: The presence of FHR tracing abnormalities was associated with an increased risk of perinatal mortality and neonatal morbidity. There was significantly higher Caesarean Delivery (CD), low APGAR scores, higher requirement of neonatal resuscitation and admission to NICU and higher perinatal deaths among abnormal FHR tracing group.Conclusions: 1) The presence of abnormal FHR tracing pattern in MSAF patients is associated with an increased risk of adverse perinatal outcomes. 2) Adverse fetal outcomes were also noted in patients with clear liquor but abnormal FHR tracings. 3) Similar adverse outcomes were more common in the tracing showing decelerations