Published: 2019-05-28

Association between clinical diagnosis of foetal distress with umbilical artery acidaemia at birth in women undergoing caesarean section for foetal distress

Garima Gandhi, Kavita Chandnani


Background: The risks of maternal morbidity and mortality associated with a caesarean section may not be reasonably justified by the degree of neonatal compromise at birth associated with caesarean section done for clinically diagnosed foetal distress. The aim was to study the association of clinical diagnosis of non-reassuring foetal status with umbilical artery acidaemia at birth in women undergoing caesarean section for foetal distress and to evaluate outcomes in neonates born by caesarean section performed for foetal distress.

Methods: Prospective observational study of all the women undergoing emergency caesarean section for foetal distress at a tertiary care teaching facility over 2 months. Criteria for diagnosis of foetal distress were thick meconium stained liquor only or foetal heart rate abnormality with or without meconium stained liquor. Testing for pH was done on arterial blood drawn from umbilical cord at the time of birth. Acidaemia was defined as cord blood pH less than 7.2.  Severe acidaemia was defined as cord blood pH less than 7.0.

Results: Cord blood pH was analysed in 110 caesareans done for foetal distress. Incidence of neonatal acidaemia at birth in study population was 53.6%.

Conclusions: Much lower incidence of actual acidaemia and low Apgar scores in neonates born by caesarean section done for clinical diagnosis of foetal distress than previously reported indicate the need for more stringent criteria and more objective tests for diagnosis of foetal distress.


Caesarean, Cord blood pH, Foetal distress

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Whitfield JM, Charsha DS, Chiruvolu A. Prevention of meconium aspiration syndrome: an update and the Baylor experience. Proc (Bayl Univ Med Cent). 2009;22(2):128–131.

Blickstein I, Tamar G. Umbilical cord blood gases. Clin Perinatol. 2007;34(3):451-9.

ACOG Committee Opinion No. 348, November 2006: Umbilical cord blood gas and acid-base analysis. Obstet Gynecol. 2006;108(5):1319-22.

Jonathan M. Whitfield MB, Dianne S. Charsha RNC, Chiruvolu A. CDC NCHS data brief. Centers for Disease Control and Prevention. 2009;22(2):128-131.

Kambo I, Bedi N, Dhillon BS, Saxena NC. A critical appraisal of cesarean section rates at teaching hospitals in India. Int J Gynaecol Obstet. 2002;79(2):151-8.

Rotich SK, Ndavi MP, Rukaria-Kaumbutho R, Kigondu CS. Early perinatal outcome in cases delivered through Caesarean section following clinical diagnosis of severe foetal distress at Kenyatta National Hospital. East Afr Med J. 2006;83(5):250-8.

Van Bogaert LJ, Misra A. Neonatal outcome after caesarean birth for fetal distress and/or meconium staining in a South African rural setting. J Obstet Gynaecol. 2008;28:56-9.

Harper MA, Byington RP, Espeland MA. Pregnancy-related death and health care services. Obstet Gynecol. 2003;102(2):273-8.

Oladapo OT, Lamina MA, Sule-Odu AO. Maternal morbidity and mortality associated with elective caesarean delivery at a university hospital in Nigeria. Aust N Z J. Obstet Gynaecol. 2007;47:110-4.

Ozumba BC, Anya SE. Maternal deaths associated with caesarean section in Enugu, Nigeria. Int J Gynecol Obstet. 2002;76:307-9.

Huisjes HJ, Aarnoudse JG. Arterial or venous umbilical pH as a measure of neonatal morbidity? Early Hum Dev. 1979;3:155.

Sykes GS, Johnson P, Ashworth F. Do Apgar scores indicate asphyxia? Lancet J. 1982:494.

Low JA, Cox MJ, Karchrner EJ. The prediction of intrapartum foetal metabolic acidosis by foetal heart rate monitoring. Am J Obstet Gynaecol. 1981;139:299-305.

Roy KK, Baruah J, Kumar S, Deorari AK, Sharma JB, Karmakar D. Caesarean section for suspected foetal distress, continuous foetal heart monitoring and decision to delivery time. Indian J Pediatr. 2008;75(12):1249-52.

Oladapo OT, Sotimehin SA, Ayoola-Sotubo O. Predictors of severe neonatal compromise following caesarean section for clinically diagnosed foetal distress. West Afr J Med. 2009;28(5):327-32.

Ajah LO, Ibekwe PC, Onu FA, Onwe OE, Ezeonu TC, Omeje I. Evaluation of clinical diagnosis of fetal distress and perinatal outcome in a low resource Nigerian setting. J Clin Diagn Res. 2016;10(4):8-11.

Kumar N, Suman A, Sawant K. Relationship between immediate postpartum umbilical cord blood pH and fetal distress. Int J Contemp Pediatr. 2016;3:113-9.