Introduction: Category II FHR tracings of the three-tiered classification system are indeterminate and include a wide variety of possible tracings that do not fit in either Category I (normal) or Category III (abnormal) tracings. To further categorize the indeterminate pattern, the 5-tier color coded system was introduced by Parer and Ikeda. Objective: To correlate the five-tier color coded category for intrapartum electronic fetal monitoring with the neonatal outcome. Methodology: A prospective cohort study was done on patients 15- 44 years old with singleton pregnancies who delivered vaginally or by primary cesarean section due to fetal distress, and with cardiotocographic (CTG) tracing obtained within 2 hours prior to delivery. Subjects were included during their prenatal check-ups at the outpatient department or during emergency room admission. They were monitored using the electronic fetal monitor during labor their room/delivery room/operating stay. After the delivery, arterial cord blood was submitted to the laboratory for umbilical cord ph analysis. APGAR scores (5, 10 minutes) were assessed. The single investigator correlated the five-tier color coded category using the color-coded chart of Parer and Ikeda. Primary neonatal outcomes of umbilical cord ph and APGAR score and the secondary outcomes of NICU admission, need for ventilator support, neonatal sepsis and length of hospital stay were determined. Results: One Among the 91 subjects, hypertensive disorders, maternal cardiac problems and babies with IUGR were significantly correlated with the five-tier color coded category (p=0.05, 0.007 and 0.003, respectively). It was also correlated with primary outcomes of APGAR score and umbilical cord pH. Conclusion: The five-tier color coded system is correlated with acidemia, poor APGAR score and the development of an adverse neonatal outcome thus, it becomes a stepwise approach for an obstetrician knowing when to intervene and when to do an expectant management.
ISSN 0031-7799 (Print)
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