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Fetal cardiotocography and acid-base status during cesarean section
R Matorras1, C Tacuri, A Nieto
1Department of Obstetrics and Gynecology, Hospital from Cruces, Baracaldo, Vizcaya, Spain.
Objective:
To assess the fetal well-being during cesarean section, in relation to the previous fetal condition.
Design:
Observational study.
Setting:
University Hospital. PATIENTS PARTICIPANTS: 204 women undergoing cesarean section (203 intrapartum cesarean sections): 177 with general anesthesia and 27 with spinal anesthesia.
Material And Methods:
We compared the fetal heart records of the last 30 min before cesarean section (during the first stage of labor) with those during cesarean section. Scalp blood analysis 30 min before the beginning of anesthesia induction was compared with umbilical artery analysis at delivery.
Main Outcome Measures:
Cardiotocography. Acid-base analysis. Apgar scores.
Results:
During cesarean section there was a reduction in uterine activity, an increase in silent tracings and a decrease in late decelerations. Umbilical artery pH was lower than scalp pH (7.23+/-0.06 vs 7.30+/-0.06). Oxygen saturation was also lower (14.43+/-8.58% vs 18.99+/-8.4%). The values of pCO2 and of base deficit were higher. During cesarean section low values of modified Fischer scores were associated with low pH values of umbilical artery and low Apgar scores.
Conclusion:
Silent tracings appearing during cesarean section usually do not indicate fetal distress. Poor intracesarean fetal heart tracings were associated with worse indicators of neonatal well-being. Although umbilical pH were lower than scalp values, when the correction described in the literature was applied, the difference was of little clinical relevance. It is concluded that anesthesic, pharmacological and surgical events have slight repercussion in fetal well being. However, in a few cases fetal heart monitoring during cesarean section could detect otherwise undiagnosed cases of transient acidemia or depression in the fetus.