Delivery of a Fetus with a Non-Reassuring Status Is Associated with Significant Maternal Morbidity

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Neonatal Health

Background:

• Labor management often prioritizes neonatal outcomes when non-reassuring fetal status (NRFS) arises.
• Maternal morbidity associated with NRFS requires further investigation.

Purpose of the Study:

• To explore the association between NRFS and maternal morbidity.
• To test the hypothesis that NRFS delivery leads to significant maternal morbidity.

Main Methods:

• Retrospective cohort study of 27,886 deliveries (2013-2016).
• Inclusion criteria: maternal age >18, singleton pregnancy, live birth, gestational age ≥37 weeks.
• NRFS defined by umbilical cord pH ≤7.00, fetal bradycardia, late decelerations, or umbilical artery base excess ≤-12.
• Propensity score adjusted odds ratios (AORPS) derived using multivariate logistic regression.

Main Results:

• Low umbilical artery pH (≤7.00) linked to increased blood transfusion (AORPS 6.83), readmission (AORPS 12.6), and cesarean delivery (AORPS 5.76).
• Fetal bradycardia associated with transfusion (AORPS 2.13) and ICU admission (AORPS 3.22).
• Late decelerations correlated with cesarean delivery (AORPS 1.65), chorioamnionitis (AORPS 2.88), and antibiotic need (AORPS 1.89).
• Umbilical artery base excess ≤-12 associated with readmission (AORPS 6.71), chorioamnionitis (AORPS 1.89), and antibiotic need (AORPS 1.53).

Conclusions:

• NRFS is significantly associated with adverse maternal outcomes.
• Increased rates of blood transfusion, ICU admission, infection, and readmission observed in NRFS cases.
• Proactive strategies are needed to minimize maternal complications during NRFS management.