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Caesarean Section for Foetal Distress and Correlation with Perinatal Outcome
Richa Gangwar1, Sarita Chaudhary1
1Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India.
Background:
The main documented indication of intrapartum caesarean section is foetal distress (MacKenzie and Cooke in BMJ 323(7318):930, 2001). Foetal distress indicates foetal hypoxia and acidosis during intrauterine life.
Purpose:
To correlate the diagnosis of foetal distress and perinatal outcome.
Methods:
This was a prospective observational study of women who underwent caesarean section for foetal distress as detected by cardiotocography and not responding to intrauterine resuscitation. The foetal Apgar score at 1 and 5 min was recorded and cord blood pH was measured in all cases. The neonatal outcome was studied with regard to the need for supportive ventilation and admission to NICU/nursery.
Results:
In our study, 14.38 % cases diagnosed with foetal distress subsequently had poor outcome. Twenty-one babies had a 5-min Apgar score <7, required immediate resuscitation and were admitted in NICU. Twelve foetuses had a 1-min Apgar score <4, while there were three cases of severe birth asphyxia (Apgar score <4 at 5 min); of these, two babies died. The neonatal outcome was poorer in cases with associated complicating factors.
Conclusion:
The diagnosis of foetal distress is imprecise and a poor predictor of foetal outcome-the result is a tendency for unnecessary caesarean sections. On the contrary, lack of adverse outcome could reflect that our unit makes decisions at a time before clinically significant foetal compromise occurs.
