Background: The global rise in caesarean section rates has become a public health concern, with non-reactive cardiotocography (CTG) frequently cited as a leading indication. Predictive value of CTG, especially when non-reactive, often leads to surgical intervention without always correlating with adverse neonatal outcomes.

Objective: This study aims to evaluate the increasing rate of caesarean sections attributed to non-reactive CTG and investigate the correlation between non-reactive CTG findings and actual neonatal outcomes. 

Methodology: The prospective observational study was carried out in “Department of Gynaecology and Obstetrics” at Ad-din Women’s Medical College and Hospital, from 2023 to October 2023. Approval of the institutional ethical review committee was taken before the commence of the study. This study was conducted on pregnant women who underwent caesarean section due to non-reactive CTG. Neonatal outcomes was assessed using APGAR scores, NICU admission, and other relevant clinical indicators. 

Results:  The study involved 334 patients at Ad-din Women’s Medical College and Hospital. During the study period, 6,709 cesarean sections were performed, with 5% (approximately 4.98%) attributed to non-reactive cardiotocography (CTG) findings. The maternal age ranged from 20 to 39 years, with a mean age of 25.7 ± 4.84 years. Gestational age at delivery ranged from 34 to 42 weeks, with a mean of 37.4 ± 2 weeks. CTG was conducted antepartum in 58.7% of cases and intrapartum in 41.3%. The most common CTG abnormality observed was loss of variability, noted in 45.5% of cases. Per-operative findings revealed meconium-stained amniotic fluid in 70 cases (21%) and nuchal cord (umbilical cord around the neck) in 95 cases (28.4%). Among the newborns, 261 (78.1%) had a satisfactory APGAR score (>7), while 73 (21.9%) scored below 7. A total of 68 neonates (20.4%) required admission to the Neonatal Intensive Care Unit (NICU), and there were 16 neonatal deaths (4.8%).

Conclusion: Understanding the relationship between non-reactive CTG and neonatal outcomes is critical for guiding clinical decisions, potentially reducing unnecessary caesarean deliveries and improving maternal and neonatal care.

Rahima Khatun is an Associate Professor in the Department of Gynaecology and Obstetrics at Ad-din Women’s Medical College and Hospital in Dhaka, Bangladesh. She completed her MBBS from Sylhet MAG Osmani Medical College in 2003, laying the foundation for her career in women’s health. To further develop her clinical and academic expertise, she obtained the FCPS in Gynaecology and Obstetrics from the Bangladesh College of Physicians and Surgeons in 2014. Her principal area of interest is obstetrical emergencies, where timely and skilled management is critical for improving maternal and neonatal outcomes. She is committed to research that enhances evidence-based practice and strengthens emergency preparedness across maternal healthcare settings in Bangladesh. In addition to her clinical work, she is actively involved in teaching medical students and supervising junior doctors—roles she considers essential for training future clinicians. She is a life member of the Bangladesh College of Physicians and Surgeons as well as the Obstetrical and Gynaecological Society of Bangladesh. She has authored fifteen scientific publications on various aspects of obstetrics and gynaecology. She also serves as a member of the AWMC Journal, contributing to scholarly advancement and promoting research within her institution and internationally.