Analysis of antepartum cardiotocography based on S/k proportions and probability in 20 minutes

Abstract Objectives: although mortality and perinatal asphyxia in newborns have been considerably reduced, there are still deficiencies in screening and diagnosis methods for intrapartum fetal well being that aim to detect its early alterations. Therefore, the purpose of this research was to apply a methodology based on probability and entropy and confirm its capacity to detect normal and abnormal fetal cardiac dynamics from 20-minute cardiotocographic tracings. Methods: 80 cardiotocographic tracings of pregnant women in the last trimester were collected, of which the minimum and maximum fetal heart rate were evaluated every 10 seconds, as well as its repetitions along with their probability and the diagnostic S/k ratio. Finally, the statistical analysis was carried out to establish the diagnostic capacity of the method concerning the clinical evaluation and interpretation of the cardiotocographic tracing, taken as the Gold Standard. Results: it was confirmed that S/k ratio values differentiated normal from abnormal fetal cardiac dynamics with sensitivity and specificity values of 100% and a Kappa coefficient of 1. Conclusion: the applicability of a diagnostic mathematical method of cardiotocography was confirmed, which suggests its implementation in the clinical context to detect alterations in fetal well-being in 20 minutes.

General versus regional anaesthesia for caesarean section indicated for acute foetal distress: a retrospective cohort study

BACKGROUND

Acute foetal distress (AFD) is a life-threatening foetal condition complicating 2% of all pregnancies and accounting for 8.9% of caesarean sections (CS) especially in developing nations. Despite the severity of the problem, no evidence exists as to the safest anaesthetic technique for the mother and foetus couple undergoing CS for AFD. We aimed to compare general anaesthesia (GA) versus regional (spinal and epidural) anaesthesia in terms of their perioperative maternal and foetal outcomes.

METHODS

We carried out a retrospective cohort study by reviewing the medical records of all women who underwent CS indicated for AFD between 2015 to 2018 at the Douala General Hospital, Cameroon. Medical records of neonates were also reviewed. We sought to investigate the association between GA, and regional anaesthesia administered during CS for AFD and foetal and maternal outcomes. The threshold of statistical significance was set at 0.05.

RESULTS

We enrolled the medical records of 117 pregnant women who underwent CS indicated for AFD. Their mean age and mean gestational age were 30.5 ± 4.8 years and 40 weeks respectively. Eighty-three (70.9%), 29 (24.8%) and 05 (4.3%) pregnant women underwent CS under SA, GA and EA respectively. Neonates delivered by CS under GA were more likely to have a significantly low APGAR score at both the 1st (RR = 1.93, p = 0.014) and third-minute (RR = 2.52, p = 0.012) and to be resuscitated at birth (RR = 2.15, p = 0.015). Past CS, FHR pattern on CTG didn't affect these results in multivariate analysis. Adverse maternal outcomes are shown to be higher following SA when compared to GA.

CONCLUSION

The study infers an association between CS performed for AFD under GA and foetal morbidity. This, however, failed to translate into a difference in perinatal mortality when comparing GA vs RA. This finding does not discount the role of GA, but we emphasize the need for specific precautions like adequate anticipation for neonatal resuscitation to reduce neonatal complications associated with CS performed for AFD under GA.