Publication:

Antenatal risk factors in emergency caesarean sections done for fetal distress

Background Fetal distress is an important indication for emergency caesarean deliveries. The objective of this study is to identify the antenatal and intrapartum risk factors in emergency caesareans done for non-reassuring fetal status and compare with patients who underwent emergency caesareans for other indications.

Methods It was a retrospective study and data was collected from the labour room records of a tertiary care hospital. Patients undergoing emergency caesareans for fetal distress were the cases and the remaining emergency caesareans were the controls. Data was statistically analyzed.

Results There were 5184 deliveries during this period of which, 669 were emergency caesareans. 126 (18.83%) of these were due to fetal distress/ non-reassuring fetal status and 543 (81.17%) were for other indications. Caesarean due to fetal distress accounted for 2.43% of the total deliveries. There were more primigravidae (61.11% Vs 46.04%) in the fetal distress group (Odds Ratio 1.84, p=0.003). Intra uterine growth restriction (OR 5.44, p<0.0001) and antepartum haemorrhage mainly due to abruption (OR 11.19, p <0.0001) were other important antenatal risk factors. Those with neonates of birth weight between 1.5 to 2.0 kgs were more likely to undergo emergency caesarean for fetal distress (OR 1.78, p=0.0435). The risk of a lower APGAR was higher in the fetal distress group (12.59%). 28.34% neonates in this group required NICU admission.

Conclusions Primiparity, intrauterine growth restriction, antepartum hemorrhage and prematurity, have shown to significantly increase the risk of emergency cesareans due to non-reassuring fetal status. We need to improve antenatal care with a goal of early detection of the above risk factors for timely institution of appropriate intervention and thus contributing to a reduction of emergency caesareans due to fetal distress.