Etude des anomalies du rythme cardiaque fœtal observées à l’examen cardiotocographique à Lubumbashi: cas suivis aux Cliniques Universitaires de Lubumbashi et à l’Hôpital Général du Cinquantenaire Karavia

Cardiotocography (CTG) has recently come into use in Lubumbashi but no thorough study has yet been conducted to identify its impact on perinatal morbi-mortality. This study aims to determine the frequency of fetal heart rate abnormalities (FHR)in order to identify the associated factors and to propose a suitable management. We conducted a cross-sectional, descriptive study of 411 women in labour over a period of 19 months (March 2015-December 2016). In patients with pathologic FHR abnormalities, sensitivity and positive predictive value of cardiotocography in the screening test for acute fetal distress were 82.95% and 45.35% respectively. FHR abnormalities were found in two women in labour out of five. Decelerations were the most frequent FHR abnormalities observed (50.8%) with a remarkable predominance of late decelerations (22.1% of all abnormalities). The factors associated with pathological FHR abnormalities were prolonged labor (OR = 14.64, CI = 3.91-54.81), chorioamnionitis (OR = 14.56, CI = 3.83-55.34), chronic maternal anemia (OR = 4.99, CI = 1.48-16.85), primiparity (OR = 2.69, CI = 1.49-4.85), prematurity (OR = 2.90, CI = 1.51-5.54) and prolonged pregnancy (OR = 3.22, CI = 1.38-7.52). Intrauterine growth retardation and arterial hypertension were mainly associated with flat lines and late decelerations (OR = 7.79, CI = 2.50-24.30 and OR=2.74, CI = 1.31-5.72). CTG is a screening tool for the identification of acute fetal distress but with high false-positive rate (55%); it should be associated with other second-line screening tests for acute fetal distress in order to reduce this rate. Factors associated with pathologic FHR abnormalities often cause acute fetal distress thus requiring a rigorous analysis of CTG traces.