Correlation of cardiotocography abnormalities with position and attitude of the fetal head in labor

BACKGROUND: Fetal distress indicated as the cause for cesarean delivery based on cardiotocography findings most often does not reflect in the newborn assessment. Cardiotocography findings are just the decision indicators for cesarean delivery, in the background of labor abnormalities owing to deflexed head or occipitoposterior position. OBJECTIVE: This study aimed to investigate the association between cardiotocography findings and the attitude of fetal head and occiput position. STUDY DESIGN: We conducted a prospective observational study in a tertiary hospital in South India, including 304 women in labor with vertex presentation. Fetal attitude, the position of the head, labor abnormalities, and cardiotocography findings were noted. The chi-square test was applied using MedCalc software (version 19) to investigate the association of cardiotocography findings with the attitude of fetal head and occiput position. RESULTS: Cardiotocography findings had significant association with occipitoposterior position (relative risk, 1.70; 95% confidence interval, 1.32–2.19) and deflexed attitude of the fetal head (relative risk, 1.44; 95% confidence interval, 1.11–1.87). Among cases with occipitoposterior position, 10 of 42 (24%) had pathologic cardiotocography, and 19 of 42 (45%) had suspicious cardiotocography, whereas among cases with deflexed head position, these proportions were 12 of 61 (20%) and 24 of 61 (40%), respectively. CONCLUSION: Pathologic and suspicious cardiotocography tracings were more frequent in women with fetal occipitoposterior and deflexed head position. However, the association was not specific to any cardiotocography pattern.