Antenatal risk factors in emergency caesarean sections done for fetal distress

Uttara Aiyer Kohli; Sanjay Singh; Madhusudan Dey; Harpreet Kaur Bal; Atul Seth

doi:10.18203/2320-1770.ijrcog20172324

Authors

Uttara Aiyer Kohli Department of Obstetrics and Gynecology, Armed Forces Medical College, Pune, Maharashtra, India
Sanjay Singh Department of Obstetrics and Gynecology, Armed Forces Medical College, Pune, Maharashtra, India
Madhusudan Dey Department of Obstetrics and Gynecology, Armed Forces Medical College, Pune, Maharashtra, India
Harpreet Kaur Bal Department of Obstetrics and Gynecology, Armed Forces Medical College, Pune, Maharashtra, India
Atul Seth Department of Obstetrics and Gynecology, Armed Forces Medical College, Pune, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20172324

Keywords:

Abruptio placentae, Emergency caesarean, Fetal distress, Intrauterine growth restriction, Non-reassuring fetal status

Abstract

Background: Fetal distress is an important indication for emergency caesarean deliveries. The objective of this study is to identify the antenatal and intrapartum risk factors in emergency caesareans done for non-reassuring fetal status and compare with patients who underwent emergency caesareans for other indications.

Methods: It was a retrospective study and data was collected from the labour room records of a tertiary care hospital. Patients undergoing emergency caesareans for fetal distress were the cases and the remaining emergency caesareans were the controls. Data was statistically analyzed.

Results: There were 5184 deliveries during this period of which, 669 were emergency caesareans. 126 (18.83%) of these were due to fetal distress/ non-reassuring fetal status and 543 (81.17%) were for other indications. Caesarean due to fetal distress accounted for 2.43% of the total deliveries. There were more primigravidae (61.11% Vs 46.04%) in the fetal distress group (Odds Ratio 1.84, p=0.003). Intra uterine growth restriction (OR 5.44, p<0.0001) and antepartum haemorrhage mainly due to abruption (OR 11.19, p <0.0001) were other important antenatal risk factors. Those with neonates of birth weight between 1.5 to 2.0 kgs were more likely to undergo emergency caesarean for fetal distress (OR 1.78, p=0.0435). The risk of a lower APGAR was higher in the fetal distress group (12.59%). 28.34% neonates in this group required NICU admission.

Conclusions: Primiparity, intrauterine growth restriction, antepartum hemorrhage and prematurity, have shown to significantly increase the risk of emergency cesareans due to non-reassuring fetal status. We need to improve antenatal care with a goal of early detection of the above risk factors for timely institution of appropriate intervention and thus contributing to a reduction of emergency caesareans due to fetal distress.

Metrics

Metrics Loading ...

References

ACOG. Inappropriate use of the terms Fetal distress and Birth asphyxia ACOG committee opinion no. 326. Americon College of Obstreticians and Gyneologists. Obstet Gynecol. 2005;106:1469-70.

Chauhan SP, Magann EF, Scott JR,Scardo JA, Hendrix NW, Martin JN jr. Cesarean delivery for fetal distress: rate and risk factors. Obstet Gynecol Survey. 2003;58(5):337-50.

Ayres-de-Campos D, Spong CY, Chandraharan E, FIGO consensus guidelines on intrapartum fetal monitoring. Cardiotocography. Int J Gynecol Obstet. 2015;131:13-24.

Roy KK, Baruah J, Kumar S, Deorari AK, Sharma JB, Karmakar D. Cesarean section for suspected fetal distress, continuous fetal heart monitoring and decision to delivery time. Ind J of Pediatrics. 2015;75(12):1249-52.

Gangwar R, Chaudhary S. Caesarean section for fetal distress and correlation with perinatal outcome. J Obstet Gynecol India. 2016;66(S1):177-180.

David C, Lagrew MD, Melissa C, Bush MD, Anna M, McKeown MD et al. Emergent (crash) caesarean delivery: Indications and outcomes. Am J Obstet Gynecol. 2006;194(6):1638-43.

Akinola OI, Fabamwo AO, Tayo AO, Rabiu KA, Oshodi YA, Alokha ME. Caesarean section- an appraisal of some predictive factors in Lagos Nigeria. BMC Pregnancy and Child birth 2014,14:217

Patel RR, Peters TJ, Murphy DJ and the ALSPAC Study Team, Prenatal risk factors for Caesarean section.Analyses of the ALSPAC cohort of 12 944women in England. Int J Epidemiol. 2005;34:353-67.