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Abstract
The present study was performed in the maternity ward at Suez Canal University Hospital in Ismailia Governorate in the period from year 2002 to 2006.
This study is a prospective randomized controlled trial to calculate the sensitivity of fetal pulse oximetry in predicting fetal outcome in patients with non-assuring CTG, to assess the fetal outcome in women with non-assuring CTG monitored later by fetal pulse oximetry and to estimate the cesarean section rate in mothers monitored intrapartumly by fetal pulse oximetry.
The present study comprised 124 pregnant women in the active phase of the first stage of labour with a gestational age > 37 weeks and with non-assuring fetal heart rate pattern. All women had labour pains either initiated spontaneously or induced. All patients fulfilled the inclusion criteria and had none of the exclusion criteria. The study population was divided into case and control groups. Each consists of 62 women.
Women in the case group were subjected to fetal pulse oximetry. Obstetric decision was taken in women of this group according to the results of fetal pulse oximetry. Insertion of the fetal pulse oximetry sensor was done immediately after the diagnosis of non-assuring fetal heart rate pattern. Fetal pulse oximetry allowed continuous monitoring of fetal oxygen saturation and diagnosis of fetal distress and hypoxemia was done when oxygen saturation was less than 30%.
In the control group, the obstetric decision was taken without the use of fetal pulse oximetry and based only on the non assuring CTG.
In the present study, the two groups were comparable as regards maternal age, gestational age, fetal weight, incidence of post-date and parity at the time of delivery. Application of non-parametric statistical tests confirmed the absence of any statistically significant differences between the two groups regarding the previously mentioned variables indicating that both groups were matched and statistically comparable.
In the present study, we have found that in case group 80.6% of women were delivered by caesarian section and only 19.4% were delivered vaginally (12.9% instrumental delivery and 6.5% without instrumentation). While in the control group, 87.1% were delivered by caesarian section and only 12.9% were delivered vaginally (9.7% instrumental delivery and 3.2% without instrumentation). from the previous results we believe that using fetal pulse oximetry slightly reduce the caesarian section rate without reducing the overall operative delivery rate which was about 93% in both groups. These differences between case and control groups regarding the mode of delivery were statistically insignificant.
The study showed statistically significant correlation between the fetal pulse oximetry measurements and the umbilical arteru pH, PO2, PCO2 and Apgar scores.
Comparison between the group of neonates with SPO2 < 30 and the group of neonates with SPO2 > 30 regarding the neonatal outcome measured by Apgar scores declared that Apgar scores are clearly lower in the first group. This difference in the mean Apgar score between the two groups is highly statistically significant. Similarly, patients with SpO2<30 showed significantly lower mean umbilical artery pH.
The sensitivity of fetal pulse oximetry in this study was 77.3%. Its specificity was 95%. Positive predictive value was 89.5% and the negative predictive value was 88.4%. The likelihood ratio for positive results was 15.5 while the likelihood ratio for negative results was less than 0.24.
We recommend fetal pulse oximetry as a successful intrapartum monitoring tool to be applied in fetuses with non-assuring fetal heart rate patterns and in all high risk patients. We recommend not delaying the decision of CS in patients with non assuring fetal heart rate pattern and SpO2 > 30 when the progress of labor shows arrest for more than 2 hours. Most of these cases will deliver by CS due to obstructed labor or failure of progress and not fetal distress. Finally, we recommend further cost effectiveness analysis of fetal pulse oximetry.
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