الفهرس 
History of Fetal Heart Rate MonitoringOnly 14 pages are availabe for public view
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Abstract
In this study, 378 direct intrapartum fetal heart
rate tracings were analysed. Our aim was to find out
the correlation between the various fetal heart rate
patterns and fetal outcome as judged by Apgar score at
1 minute and 5 minutes, to study the fetal heart rate
patterns in preterm labour, to see the effect of
drugs given to the mother during labour on FHR
variability and to find out any complications caused
by the fetal scalp electrode.
1. Correlation of FHR patterns with Apgar score:
For correlation between various fetal heart rate
patterns and fetal outcome, the different FHR tracings
were classified as uncomplicated (Single FHR abnormality)
and complicated (FHR abnormalities occured in association)
to determine its ability to predict the fetal
status as judged by 1 and 5 minutes Apgar score. Also,
the FHR scoring system advised by Krebs et al. (1979)
was used for analysis.
The results showed that
_ Normal FHR pattern could predict good fetal outcome
and that no single FHR abnormality alone could predict
the fetal prognosis. However, when abnormal FHR patterns
occured in association, the prognostic significance
of intrapartum FHR monitoring was much improven.
- By using the FHR scoring system advised by Krebs et
al. (1979), it was observed that there was increase
in the mean Apgar score at 1 minute and 5 minutes
with increase in the FHR scores and that the lower the
FHR scores, the higher was the incidence of neonates
with Apgar score less than 7 at 1 minute and 5 minutes.
This FHR scoring system allowed classification of FHR
patterns into abnormal FHR scores (5 or less) which carried
unfavourable prognosis demonstrated by 95.5% low
1 minute and 47.7% low 5 minutes Apgar score, suspicious
FHR scores (6 and 7) which were associated with 53.3%
low 1 minute Apg~r score, but only 3.3% low 5 minutes
Apgar score and normal FHR scores (8 or more) which were
associated with .13.9% low 1 minute and 1.5% low 5 minutes
Apgar score ~ess than 7).
_ Suspicious FHR scores can be considered as compensated
distress pattern and usually associated with some FHR
patterns, representing good fetal reserve as normal FHR
variability or sporadic acceleration 5 or more while in
abnormal FHR scores, these signs of fetal reserve are
usually absent and can be considered as decompensated
distress pattern.
2. Fetal heart rate patterns in preterm la~our
Although the results showed that there was no
statistically significant difference in the incidence
of various abnormal FHR patterns between preterm and
full term, low risk labour, yet, when the tracings were
classified into uncomplicated and complicated and correlated
with the neonatal Apgar score, the results showed
that, for any given tracing preterm labour, compared to
term labour was associated with a higher incidence of
neonates with Apgar score less than 7 at 1 minute and
5 minutes, supporting the view that hypoxic FHR patterns
in preterm fetuses are sufficient to warrant intervension
without supporting acid-base determination.
3. Effect of drugs on FHR variability:
The results showed that pethidine 100 mg or diazepam
10 mg Intramuscular when given to the mother during labour
could depress the fetal heart rate variability. However,
this was not a constant finding, since it occured in only
38.57% of cases who received pethidine and in 42.86% of
cases who received diazepam. The effect of pethidine
was after 20.63±6.21 minutes and that for diazepam
was 18.33+3.51 minutes. The duration of action for
pethidine was 50.78+10.23 minutes and that for diazepam
was 52.33+2.88 minutes. The difference between the
two drugs in the time onset and duration of action
was not statistically significant.
4. Complications of fetal scalp electrode:
The results showed that, both traumatic and infectious
complications of fetal spiral scalp electrode
were very rare. Traumatic complication occured only in
one fetus out of 378 fetuses in which the electrode was
applied wrongly on anterior fontanelle but did not lead
to any serious sequele while infectious complication was
not reported in 172 neonates followed for 5 to 7 days.
5. Other variables
AF Parity:
The results did not show any statistically significant
differences between various parities and the frequeneyof
abnormality of the tracings or the incidence of
A~gar score less than 7 at 1 minute and 5 minutes.
B) High risk eases :
The results showed that, for any given tracing,
high risk cases usually had a higher incidence of neonates
with Apgar score less than 7 at 1 minute and 5 minutes
than low risk cases. Results supporting the view
that all high risk cases should have electronic FHR
monitoring during labour.
C) MeconiW1Iand blood staining of l.iquo» amnii:
The results showed that there was increased incidence
of complicated tracings in the meconium stained
liquor amnii group (52.56%, compared to clear liquor
amnii group (29.59%). Also, it was observed that for
any given tracing there was usually increased incidence
of low Apgar score both at 1 minute and 5 minutes in
the meconium stained liquor amnii group compared to clear
liquor amnii group. Similar results were observed
for blood stained liquor amnii group.
D) Card cOI1fP liaations :
The results showed that there was statistically
significant difference in the incidence of variable
deceleration and loss of acceleration in cases with
cord around the neck compared to cases without apparent
cord complications (P ~0.01). The difference in
the incidence of other abnormal FHR patterns between
the two groups was statistically insignificant (P>0.05).
E) Impact of intrapartum fetal. heart rate monitoring on
Cesareansection rate :
The results showed that the incidence of Cesarean
section for fetal distress was 6.1%. Most of cases
were performed for complicated FHR abnormalities and
were associated with 94.4% incidence of Apgar score
less than 7 at 1 minute and 33.3% incidence of Apgar
score less than 7 at 5 minutes. It seems that with proper
analysis of FHR tracings, intrapartum FHR monitoring
did not increase the Cesarean section rate.