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Caesarean Section for Foetal Distress and Correlation with Perinatal Outcome

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Original Research Article Caesarean section for foetal distress and correlation with perinatal outcome Parikh Rana1, Pooja Sharma2*, Sandeep Sharma3, Mandeep Sharma4, Preeti Chouhan5 1Lecturer, 2Registrar, Department of Gynecology and Obstetrics, SMGS GMC Jammu, INDIA. 3Registrar, 4Surgeron, 5PG Student, Department of Medicine, Government Medical College, Jammu, INDIA. Email: [email protected] Abstract Objective: To find out the efficacy of continuous fetal heart monitoring by analyzing the cases of cesarean section for non-reassuring fetal heart in labor, detected by cardiotocography (CTG) and correlating these cases with perinatal outcome. Methods: This was a prospective observational study of 200 patients who underwent cesarean section at 36 weeks fornon-reassuring fetal heart in labor detected by CTG. The adverse immediate neonatal outcomes in terms of Apgar score <7 at 5 minutes, umbilical cord þH <7.2, neonates requiring immediate ventilation and NICU admissions were recorded. The correlation between non-reassuring fetal heart and neonatal outcome was analyzed. Results: Out of the 1010 caesarians,200 (15.54%) are being performed for non-reassuring fetal heart rate. The mean age of the patients in the study group was 24.1 years. 128 (64%) women were primigravida, 72 (36%) were multigravida. Only 29 (14.5%) actually shows poor neonatal outcome with NICU admission. Conclusion: Non-reassuring fetal heart rate detected by CTG did not correlate well with adverse neonatal outcome. Key Word: Foetal distress, perinatal outcome. *Address for Correspondence: Dr. Pooja Sharma, Registrar, Department of Gynecology and Obstetrics, SMGS GMC Jammu, INDIA. Email: [email protected] Received Date: 14/08/2018 Revised Date: 13/09/2018 Accepted Date: 23/10/2018 DOI: foetal heart rate patterns are associated with adverse Access this article online perinatal outcome. Quick Response Code: Website: MATERIALS AND METHODS www.medpulse.in This was a prospective observational study done in SMGS hospital in May, April 2018. A total of 200 women were included in the study who underwent Accessed Date: emergency caesarean section for foetal distress during 26 October 2018 labour as detected by cardiotocography and not responding to intrauterine resuscitation. Intrauterine resuscitation included change in maternal position, oxygen administration and intravenous hydration. INTRODUCTION Inclusion Criteria Fetal distress detected by cardiotocography (CTG) has 1. Caesarian section delivery; been the most common indication for cesarean section 2. Term gestation (at 36 weeks or above); (CS) for the past few decades. Many fetuses show heart 3. Cephalic presentation. rate changes without showing poor outcome and CTG has 4. Live birth. been criticized to createan unnecessary high rate of 5. Singleton pregnancies. operative deliveries.1,2,3 Hence, there is a need to assess Exclusion Criteria: Were congenital anomalies, the efficacy of electronicfoetal monitoring. Keeping this abnormal presentation, multiple gestation and gestational issue into consideration, this study was undertaken to age<36 weeks, low birth weight. Maternal age, parity, analyse the correlation between caesarean section for associated high-risk factors and abnormal foetal heart rate foetal distress and perinatal outcome and to see what patterns which led to the diagnosis of caesarean section were recorded. Birth weight, foetal Apgar score at 1 and 5 How to cite this article: Parikh Rana, Pooja Sharma, Sandeep Sharma, Mandeep Sharma, Preeti Chouhan. Caesarean section for foetal distress and correlation with perinatal outcome. MedPulse – International Medical Journal. October 2018; 5(10): 97-99. http://www.medpulse.in MedPulse – International Medical Journal, ISSN: 2348-2516, EISSN: 2348-1897, Volume 5, Issue 10, October 2018 pp 97-99 min and umbilical artery pH at birth were recorded. Table 2: Relation of neonatal outcome with associated risk factor Neonatal outcome was studied with regard to the need for Associated high risk Total number of NICU supportive ventilation and admission to NICU/nursery. factor cases admission Meconium stained liquor 35 11 RESULTS Oligohydroamnious 10 3 Cord around neck 6 3 This study was conducted in SMGS hospital from April Second stage of labor 6 2 to May 2018, a total number of 2039 patients were Antepartum hemorrhage 2 1 delivered at ≥36-week gestation. Out of these, 200 Complicating factors with those who had no risk factor. (15.54%) patients underwent emergency caesarean Associated complicating factors included antepartum section primarily for non-reassuring foetal heart rate haemorrhage, oligohydramnios, hypertensive disorders of patterns, while the total number of caesarean sections for pregnancy, cord prolapse, cord loop around neck, various indications was 1010. The mean age of the meconium staining of amniotic fluid and second stage patients in the study group was 24.1 years. 128 (64%) arrest. In 141 (70.5 %) cases, there was no associated risk women were primigravida, 72(36%) were multigravida. factor, while the remaining 59 (29.5 %) had one or more The various foetal heart abnormalities picked up by CTG associated complicating factors. In 59 (29.5%) patients for which caesarean section was done and associated operative findings did support the clinical diagnosis of neonatal outcome are given in Table 1. The most jeopardized fetus but in 141 (70.5%) cases no evidence of common foetal heart abnormality of foetal distress fetal distress was found during surgery and most of these detected by CTG found was persistent bradycardia in had the diagnosis based on CTG readings. The most 125cases followed by late deceleration in 39 cases and common operative finding was the presence of meconium variable deceleration in 31 cases. There were 20 (10 %) detected in 35 (17.5%) patients, followed by decreased or patients who had more than one foetal heart abnormality. absent liquor in 10 (5%), loops of cord around fetal neck In our study, 14.5 % (29/200) of cases diagnosed with in 6, delivered during second stage of labor in 6 and foetal distress subsequently had a poor outcome. Out of marked placental separation in 2 cases. Poorest neonatal 200 patients of caesarean section for suspected foetal outcome was found in those cases who had only paste distress, the 1-min Apgar score was<4 in 15 women, like meconium without any liquor Twenty foetuses were while the 5-min Apgar score was<7 in 29 women. admitted in NICU or needed supportive ventilation in Twenty-ninebabies required immediate resuscitation and women with associated risk factors, while only nine were admitted in NICU. There were five cases of severe foetuses in those with no associated risk factors. Hence, birth asphyxia (Apgar score<4 at 5 min); of these, three the neonatal outcome was poorer if there were associated babies died. The indication of caesarean section was complicating factors and this was found to be statistically severe msland antepartum hemorrhage with abruption, significant using chi square test. (p<0.001). The outcome respectively. The foetal heart abnormality was persistent was worst in babies with meconium stained liquor with bradycardia in both the cases, while the cord pH was 6.12 maximum number of babies (50 %) in this group and 6.95, respectively. There were 125 (85.6 %) neonates requiring resuscitation and admission in NICU. who did not show any adverse outcome. We also analysed the intraoperative finding and associated DISSCUSSION complications in these women and compared the neonatal Continuous electronic foetal monitoring is the most outcome in cases with associated common form of intrapartum foetal assessment used currently4. When electronic fetal heart monitoring by Table 1: Various foetal heart abnormality and related adverse cardiotocography was introduced, the aim was to identify neonatal outcomes Adverse neonatal outcome fetuses affected by hypoxia during labor better. But no Foetal heart Number of AS<7 at 5 Cord pH NICU benefit in long term neonatal outcome has been shown Abnormalities patients min <7.20 admission and cesarean section rates have been reported to be 3,5 6,7 Persistent increased by four folds . Various studies implicate that 125(62.5%) 18 7 18 Bradycardia CTG interpretation is inconsistent, is at times inaccurate, Variable may fail to predict early neonatal outcome and is subject 31(15.5%) 4 2 4 Decelerations of influence by the medicolegal climate. As observed in Late 39(19.5%) 5 2 5 our study, the rate of caesarean section for foetal distress decelerations was 15.54 %, and out of this, only14.5 % foetuses were Tachycardia 5 (2.5 %) 2 1 2 actually distressed implying the limitation of cardiotocography in predicting early neonataloutcomes on the basis of non-reassuring foetal heart rate patterns. MedPulse – International Medical Journal, ISSN: 2348-2516, EISSN: 2348-1897, Volume 5, Issue 10, October 2018 Page 98 Parikh Rana, Pooja Sharma, Sandeep Sharma, Mandeep Sharma, Preeti Chouhan Hence, the prediction of foetal hypoxia and acidosis on significantly higher NICU admission rate in babies born the basis of non-reassuring foetal heart rate patterns is to them. Hence the diagnosis of fetal distress should not sufficiently low to have led to the observation that many be based on a single parameter thus eliminating the risk caesarean deliveries are retrospectively found to have of overdoing caesareans. been unnecessary. It has also been observed in various studies that CTG interpretation is inconsistent and may REFERENCES fail to predict early neonatal
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