Neonatal Outcome in Caesarean Births for Unexplained Fetal Distress

Abstract

Background: Appropriateness of caesarean section (CS) for foetal distress (FD) is proved by neonatal status at birth. Validity is known after intervention has been done, whether justified CS or not. It provides information about delays also.

Objectives: Objectives were to know burden of CS for FD in women with no apparent risk factors, factors detected during CS, accuracy of diagnosis, whether really FD or false alarm.

Material Methods: Five years records of births were analysed for knowing about CS for FD in women with no obvious risk factors, neither in history, nor clinical examination or day to day investigations which could have lead to diagnosis of FD. Approval of institute’s ethics committee was taken. Analysis of records of women who had CS (2121) performed for FD as primary indication, revealed that 38.15%, (809 of 2121 CS for FD), were study subjects, no risk factor.

Clinical diagnosis of unexplained FD contributed to 10.6% of CS, 15.2% of emergency CS, 3.7% of births during study period. Details of CS, intra-operative findings, status of liquor amnii, placenta, umbilical cord vessels, status of baby at birth beyond were recorded.

Results: Of 809 cases, 6 (0.8%) were teenagers, 569 (70.33%) of 20-24 yrs, 705 (87.14%) were primigravida, actually 95.67% were nullipara, highly significantly (P<0.01) more primigravida than over all 45% primigravida. 11.99%, (97 of 809) CS were performed at less than 34 weeks gestation. FD was diagnosed by any one or two or all three, nonstress test, moderate or thick meconium in liquor or persisting foetal tachycardia or bradycardia. NST recorded category – III (non reassuring foetal heart) in 395 (48.83%) women, in others 48.83% (395 of 809) it was moderate or thick meconium in liquor amnii, persistent foetal bradycardia, moderate (<100 bpm) or severe (<80 bpm) in 2.6%, (21 of 809), persisting foetal tachycardia (>180 bpm) in 6.18% (50 of 809). Baby was vigorous at birth in 353 (43.63%), 427 (52.78%) required NICU admission. Of them, 241 (56.44%) improved, survived, but 186 (43.56%) died, 29 (3.58%) were still born. Overall loss of 26.5% in CBs for FD is, a matter of concern.

Conclusion: Many CS were performed in women without risk factors with diagnosis of FD. In quite a few it was proved that intervention was needed and also in some delayed too, but in some it seemed to be unwanted intervention. Studies are needed to search for non-conventional or unknown risk factors for FD, also for authentic modes of knowing non-reassuring foetal status. Once diagnosed it is essential to have best outcome by quick right, interventions.