Neonatal outcomes in cesarean deliveries for non-reassuring fetal status.

Abstract

Objectives: To determine the rate and neonatal outcomes of cesarean deliveries performed for non-reassuring fetal status at 2 large hospitals in Rwanda. Methods: This was a retrospective cross sectional study. Case files were used to collect data. Data entry and analysis were done with SPSS version 23. We assessed the prevalence of cesareans performed for non-reassuring fetal status and the neonatal outcomes. Types of fetal heart rate abnormalities, decision to delivery interval and presence of meconium were correlated to fetal outcomes. Statistical analysis was carried out by chi- square. Level of significance was set at P value <0.05. Results: The prevalence of Cesarean section for non-reassuring fetal status was 17.5%. Persistent fetal bradycardia was the most common fetal heart rate abnormality (53%). The decision to delivery interval of 30 min was met in 38.6%. Most of the neonates (88.1 %) had a reassuring Apgar at 5 minutes. 17.2% required ventilation at birth, 12.9 % were admitted in NICU and 1.1% were stillbirths. The presence of meconium was 11.3 %. Fetal tachycardia and bradycardia were significantly associated with the need for neonatal ventilation (p=0.014, p=0.04). Fetal tachycardia and decelerations were associated with low 5 minute Agars (p=0.028, p=0.004). No fetal heart rate abnormality predicted NICU admission. The presence of meconium was associated with low Apgars, NICU admission and need for ventilatory support (p<0.001). There was no statistical significance in outcomes stratified by decision to delivery interval. Conclusion: The type of non-reassuring fetal heart tracings did not consistently predict neonatal outcomes nor did the interval to delivery. The presence of meconium was predictive of poor outcome. Therefore, when monitoring labor with non-reassuring fetal status, the presence of meconium should be incorporated into the decision to perform Cesarean section.