Prediction of neonatal acidemia at birth with total deceleration area on intrapartum cardiotocogram

Aim & objective The diagnosis of foetal distress in a clinical setting is based on foetal cardiotocography findings during labour. This study aims to analyse the total deceleration area (TDA) on intrapartum cardiotocogram which will predict neonatal acidemia at birth. Materials & methods The study participants included women in labour having intrapartum foetal distress (National Institute of Child Health and Human Development criteria category III and persistent category II on cardiotocogram), who had the 30-min traces (prior to delivery/decision to delivery) and foetal umbilical cord blood gas analysis at delivery. The TDA was calculated and analysed against the cord blood pH obtained at delivery. The deceleration area is calculated as the width of the widest aspect of deceleration (below baseline) measured in minutes which is multiplied by the maximum depth below the baseline and divided by two. TDA is the summation of all the deceleration areas in the last 30 min before delivery. Results A total of 168 participants were analysed. There were 42 cases and 146 controls in the study. The mean TDA in the case and control group was 254.62 missed beats and 165 missed beats, respectively. It was observed that an intrapartum TDA of ≥195 missed beats was associated with neonatal acidemia at birth and with an area under curve of 0.6576 (95% CI 0.5305 to 0.7847) with a positive predictive value of 83.78%. Conclusion In this study, an intrapartum TDA of ≥ 195 missed beats was significantly associated with neonatal acidemia at birth. The calculation of TDA has simplified intrapartum foetal monitoring.