Predictors of severe neonatal compromise following caesarean section for clinically diagnosed foetal distress

The potential harm to a mother and baby from caesarean delivery for clinically diagnosed foetal distress may not always be justified by the degree of neonatal depression at birth.

To assess the accuracy of clinical diagnosis of foetal distress indicating caesarean section and identify antepartum and intrapartum characteristics that may predict severe neonatal compromise at birth.

A chart analysis of 246 singleton caesarean births primarily indicated by clinically diagnosed foetal distress over a ten-year period at a Nigerian University Hospital. Gestational and intrapartum characteristics were compared for severely compromised neonates (Apgar score 0 to 3) and those with Apgar score of four-seven at one minute of birth. Multivariate logistic regression analysis was applied to determine independent predictors of severe neonatal compromise.

Apgar score was less than 7 in 236 neonates: 120 (48.8%) were severely compromised, 116 (47.2%) had Apgar scores of four-seven and ten (4.1%) had normal Apgar scores. Eight (3.3%) neonates were stillborn. Multivariate logistic regression analyses indicate that meconium liquor (adjusted OR, 0.24 CI: 0.12 to 0.46) and long admission to diagnosis interval significantly reduce while combination of abnormal FHR and meconium liquor (adjusted OR: 3.84 CI: 1.89 to 7.76) significantly increased the odds of severe neonatal compromise at birth.

Clinical diagnosis of foetal distress is valuable in identifying foetuses in need of expedited delivery in this setting. However, gestational and intrapartum characteristics have limited impact in predicting before delivery which foetus requires intensive resuscitative measures and neonatal support at birth.