BACKGROUND: Continuous electronic fetal monitoring has been under close scrutiny due to lack of consistent interpretation of fetal heart rate tracings, even by perinatologists. In 2008, NICHD revised their definitions, interpretation and research guidelines. ACOG incorporated these guidelines into a 2009 practice bulletin on EFM definitions and the three-tiered fetal heart rate interpretation. After a year of adapting the new classification, the Department of Obstetrics and Gynecology of tertiary hospitals has yet to evaluate locally its use in fetal surveillance during labor and subsequently its value in decision-making. To date, no local study has been published regarding the neonatal outcome of those women whose intrapratal tracings were categorized under the three-tier system.
OBJECTIVES: This study aimed to describe the neonatal outcomes of patients with Category I, II, and III traces among pregnant patients admitted in a tertiary hospital. This included APGAR score and disposition of the neonate as primary outcomes.
METHODS: This was a prospective cohort study. It was conducted in a tertiary hospital from December 2012 to July 2013. The population consisted of women admitted in the labor room for delivery and underwent intrapartal monitoring and eventually delivered. Inclusions were term or preterm pregnancy ? 34 weeks, singleton pregnancy with no known congenital or lethal fetal anomalies. Exclusions were women with clinically evident chorioamnionitis on admission, multifetal gestations, preterm pregnancy (less than 34 weeks), post-term pregnancy, women who were mentally incapacitated to give consent, and those for outright cesarean section indications. There was no specified number of subjects but all laboring patients who underwent trial of labor in were included. Data was analyzed using descriptive analysis and z-test for proportion. And these data were held confidential. Reading and interpretation of the traces was made by perinatologist fellow on duty. Neonatal outcomes, on the one hand, including the APGAR score were analyzed by pediatrician on duty.
RESULTS: There were a total of 163 subjects included in the study, with age range of 19-33 years old. Subjects were G1P0 to G9P6, with a mean prenatal check-up of 5 times. Among the 163 subjects, 134 had a Category I trace and 17 had Category II traces all through- out their laboring period, and the remainder had combination of category I and II traces. There was no Category III trace observed. For Category I trace, 97.8% of babies had a one minute APGAR score of 7-9, 1.5% had a one minute APGAR score of 4-6, and 0.7% had a one minute APGAR score of 1-3. The five-minute APGAR score with Category I trace were as follows: 99.3% had APGAR score of 7-9, 0.7% had APGAR score of 4-6, but there was none with a five-minute APGAR score of 1-3. Majority (63.4%) of the babies in Category I were direct room-in, 14.9 % were high-risk direct room-in, 10.4% babies were admitted in Neonatal Intensive Care Unit 2 (NICU2) and 11.2% in NICU3. Three (2.2%) of the babies in NICU3 were intubated. For the Category II trace, 100% of babies had one and five minute APGAR score of 7-9. Thirteen (54.2%) of the babies were direct-room in. 37.5% of the babies were admitted in NICU2. One baby (4.2%) was admitted in NICU3 but not intubated. The resuscitative measures done were as follows: tactile stimulation, thermoregulation, suctioning, inhalation, and intubation. Among these measures, suctioning (with a p-value of .02) showed a significant difference between Category I and Category II traces. Category II traces were associated more with abdominal delivery. Spinal anesthesia which was usually used in abdominal deliveries is also significantly different from the two traces, with a p-value of 0.02. Category I traces had a significantly higher morbidity and mortality compared to Category II traces.
CONCLUSION: There was no significant difference between the one-minute and five-minute APGAR score and disposition of babies between Category I and Category II traces. Abdominal delivery, spinal anesthesia and suctioning were higher in Category II trace than in Category I trace.

Human ; Female ; Adult ; Pregnancy ; Cardiotocography ; Heart Rate, Fetal ; Apgar Score ; Gynecology ; Obstetrics ; Anesthesia, Spinal ; Intensive Care Units, Neonatal ; Chorioamnionitis ; Delivery, Obstetric ; Term Birth

BACKGROUND: Amnioinfusion, or transcervical infusion of saline into the amniotic cavity, has been proposed as a method for reducing the risk of meconium aspiration syndrome.
OBJECTIVE: This study aims to assess the effect of intrapartal amnioinfusion with meconium stained amniotic fluid on cesarean section rate, incidence of meconium aspiration syndrome, neonatal ICU admission, perinatal death and adverse maternal outcomes.
METHODS: This study is a randomized controlled trial from June to September 2013, conducted in the service wards of a university hospital. The study population consists of parturients 19-45 years old with singleton term low-risk pregnancies, in cephalic presentation, with cervical dilatation at 2-6 cm, with ruptured membranes showing meconium stained amniotic fluid.
RESULTS: Meconium aspiration syndrome occurred in one infant in the amnioinfusion group and in three infants in the control group (9% vs. 25%). There was a lower rate of neonatal pneumonia and neonatal sepsis in the treatment arm (0% vs. 8% and 9% vs. 17%, respectively). There were no perinatal deaths in both groups. Neonatal lCU admission was seen less in;the treatment arm (9% vs. 25%). The cesarean section rate did not differ significantly in both groups (9% vs. 8%). Maternal morbidity was seen less in the treatment group. None of the patients in the amnioinfusion arm had fever while two patients in the control group had pyrexia (0% vs. 17%). Hospital stay was also shorter for patients in the treatment group with an average duration of 3 days, as opposed to 4 days in the control arm.
CONCLUSION: Amnioinfusion is a relatively simple technique of reducing perinatal and maternal morbidity in patients with meconium stained amniotic fluid. Although this study did not show any significant difference between the two groups, there is a trend towards better neonatal outcomes and decreased maternal morbidity with amnioinfusion.

Human ; Female ; Adult ; Meconium Aspiration Syndrome ; Meconium ; Amniotic Fluid ; Perinatal Death ; Intensive Care Units, Neonatal ; Neonatal Sepsis ; Embolism, Amniotic Fluid ; Fever ; Pneumonia

Vertebral anomalies-anal atresia-cardiac abnormalities-tracheoesophageal fistula-renal agenesis-limb (VACTERL) defects association is a rare congenital disease. While most scientific literature focus on the clinical presentation and management of pediatric patients with this condition, this paper focuses on the challenges faced by a 22-year-old primigravid, who was able to carry a pregnancy to term, despite the many anomalies associated with being afflicted with VACTERL.
Humans ; Tracheoesophageal Fistula ; VACTERL association ; Limb Deformities, Congenital