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.
No Thumbnail Available
Date
2021-06
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Addis Abeba University
Abstract
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.
Description
Keywords
Cesearean section ,Neonatal acidemia