Obstetrics and Gynecology

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Browsing Obstetrics and Gynecology by Subject "Cesearean section ,Neonatal acidemia"

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    Cesearean Section for Intrapartum Non-reassuring Fetal Status and Prediction for Neonatal Acidemia at Birth in Tikur Anbessa Specialized Hospital: A Prospective Observational Study,2021.
    (Addis Abeba University, 2021-06) Heyi,Jemal Markos; Dr.Fantahun, Yitbarek (MD, Assistant professor of Obstetrics and Gynecology, AAU-CHS); Dr.Kebede, Eskendir (MD, Assistant professor of Obstetrics and Gynecology, AAU-CHS)
    Background: NRFS is leading indication for cesarean section. 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. Objectives: This study was undertaken to evaluate prediction of clinical diagnosis of intrapartum NRFS for significant neonatal acidemia and short term adverse neonatal outcome. Methods: Facility based prospective observation study where all the deliveries by cesarean section for NRFS over 2 months period were included. Fetal patterns prior to delivery were obtained from labor follow up chart and interpreted. The primary outcome was fetal acidemia (umbilical artery pH 7.20); short term neonatal morbidities were also assessed. Area under the receiver operating characteristic curves was used to assess the test characteristics of individual models for acidemia and neonatal morbidity. Population from historical cohort of similar study was used to calculate predictive ability of NRFS for fetal acidemia. Results: During this study period 228 deliveries occurred at the selected health facility and 98 women by cesarean section. From cesarean section 51% (50 of 98) were emergency and 56% (28 of 50) was done for NFS. Fetal bradycardia was the most common type of NRFS indicating emergency CS constituting 60% (15 of 25) of emergency CS. The mean umbilical artery PH was 7.20±0.09 (SD) (range, 7.01-7.30). Incidence of acidemia was 32% (8 of 25), while pathologic acidemia (PH <7.10) account only for 20% (5 of 25). Although significant association was not found for all patterns of NRFS, fetal bradycardia seems non predictive for fetal acidemia with area under the curve of 0.41(OR 0.42, 95% CI (.075-2.36) P value 0.4) with PPV of 17.22%, while fetal tachycardia (AUC (.62), PPV 30.69) and MSAF (AUC (.68)) appears to have a fair prediction for fetal acidemia. Conclusion: None of NFS pattern had significant association with fetal acidemia and neonatal outcome. This may be due small sample size of this study and further study with large sample size is needed to establish existing association, if any.