Kitty Elizabeth Mammen1, Heera Shenoy T2
BACKGROUND The most common indication of caesarean section has been foetal distress for the past few decades. Foetal distress indicates foetal hypoxia and acidosis during intrauterine life. The objective of this study was to correlate the diagnosis of foetal distress by different modes with perinatal outcome. MATERIALS AND METHODS Retrospective analysis of case records was carried out between January 2014 to March 2016 in the Department of Obstetrics and Gynaecology and Neonatal Intensive Care Unit, Travancore Medical College Hospital, a tertiary health care facility in South Kerala, of 112 antenatal cases who were diagnosed to have Foetal distress and undergone Caesarean section. RESULTS In our study, 88 (78.6%) were nulliparous and 64 (57.1%) were between the age group 18-25 years. The mode of diagnosis of foetal distress was 74.1% with one parameter and the method most commonly employed to diagnose was the external cardiotocography (45 cases). Predictivity value of the parameters used to identify the foetuses at jeopardy was found to be more sensitive when used in combination. 19 babies (17.0%) had a 5-minute Apgar score <7 and required immediate resuscitation. 5 Babies had a 1-minute Apgar score <4, while there were 3 cases of severe birth asphyxia (Apgar score <4 at 5 minutes) who died. The neonatal outcome was poorer in cases with associated complicating factors. CONCLUSION The clinical diagnosis of foetal distress is accurate in about a third of the cases and it has led to an unnecessary caesarean section in the remaining two thirds and do not correlate well with early perinatal outcome. The correlation was however better in cases with two parameters used together, mainly meconium stained liquor and abnormal foetal heart rate pattern. On the contrary, lack of adverse outcome could reflect that our unit makes decisions at a time before clinically significant foetal compromise occurs. The use of other modalities like foetal ECG as an adjunct to cardiotocography may help in improving the predictive value of foetal monitoring. Antepartum and Intrapartum risk factors have shown to significantly increase the risk of emergency caesarean section due to non-reassuring foetal status.
