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Abstract

Background: Cardiotocography (CTG) is a cornerstone of intrapartum fetal monitoring and plays a vital role in assessing fetal well-being during labor. Abnormal CTG patterns—such as elevated baseline fetal heart rate, reduced variability, and decelerations—are commonly linked to adverse neonatal outcomes, including low birth weight, decreased 5-minute APGAR scores, increased neonatal intensive care unit (NICU) admissions, and perinatal mortality. Despite its widespread use in tertiary care, the effectiveness of CTG relies heavily on accurate and timely interpretation to reduce unnecessary interventions and improve perinatal outcomes.
Objective: To evaluate fetal outcomes associated with pathological intrapartum CTG among term pregnant women at Abbasi Shaheed Hospital, Karachi.
Methods: A descriptive cross-sectional study was conducted over six months and included 133 laboring women at term (gestational age ≥37 weeks) with singleton pregnancies and maternal age ranging from 20 to 45 years. CTG was defined as pathological when the baseline fetal heart rate exceeded 170 bpm, variability was less than 5 bpm, or early, prolonged, or late decelerations were observed. All participants underwent standardized corrective interventions, including maternal repositioning and oxygen therapy. Data were collected using structured forms and analyzed using SPSS version 20. Associations between CTG patterns and fetal outcomes were assessed using Chi-square and Fisher’s exact tests, with statistical significance set at p ≤ 0.05.
Results: Among 133 patients, 24 (18%) neonates had low birth weight, 33 (25%) had low 5-minute APGAR scores, 13 (10%) required NICU admission, and 4 (3%) experienced in-hospital mortality. The presence of late decelerations was significantly associated with low APGAR scores (p=0.004) and NICU admissions (p=0.012).
Conclusion: Pathological CTG patterns strongly predict adverse neonatal outcomes. Timely recognition and standardized responses can enhance perinatal safety in resource-constrained tertiary care settings.