Background: Intrapartum fetal distress remains a significant contributor to perinatal morbidity and mortality, necessitating timely and accurate diagnosis. Cardiotocography (CTG) is widely used for continuous fetal monitoring; however, its predictive accuracy for fetal acidemia is limited by high false-positive rates. Umbilical artery cord blood pH serves as an objective biochemical marker for assessing fetal hypoxia and metabolic status at birth. The present study aimed to evaluate the association between cardiotocographic diagnosis of intrapartum fetal distress and immediate umbilical artery cord blood pH.

Methods: A hospital-based, prospective, observational study was conducted in the Department of Obstetrics and Gynaecology over a period of 18 months. A total of 88 antenatal women with gestational age >37 weeks in labor with singleton cephalic pregnancy and non-reassuring CTG were included. Continuous CTG monitoring was performed using a BPL Diva machine and interpreted according to NICE guidelines. Following delivery, umbilical arterial cord blood samples were collected and analyzed for pH using a blood gas analyzer. Neonatal outcomes including APGAR scores, need for resuscitation, NICU admission, and complications were recorded. Statistical analysis was done using SPSS with chi-square and t-test, considering p<0.05 as significant.

Results: The mean maternal age was 25.04±3.80 years, with majority in 21–25 years age group (56.82%). Cord blood acidosis was observed in 11 cases (12.5%). Significant associations were found between cord blood acidosis and gestational age (p=0.001), induced labour (p=0.001), meconium-stained liquor (p=0.001), and mode of delivery, with LSCS being higher in acidosis cases (81.8%, p=0.001). No significant association was found with maternal age, religion, socio economic status, gravidity, fetal movement, or Bishop score. Neonates with acidosis had significantly lower APGAR scores at 1 minute (5.18 vs 6.44) and 5 minutes (6.36 vs 8.40) (p<0.001). All acidosis cases required resuscitation and NICU admission, and 100% had birth asphyxia, showing strong association with adverse neonatal outcomes.

Conclusion: Early identification of high-risk intrapartum factors and timely obstetric intervention can reduce perinatal morbidity. Integration of CTG findings with objective biochemical assessment is essential for improving clinical decision making and neonatal prognosis.

KEYWORDS: Cardiotocography, Fetal Distress, Umbilical Cord Blood pH, Acidosis, APGAR Score.