Fetal outcome in cesarean deliveries for non-reassuring fetal status at Jaramogi Oginga Odinga teaching and referral hospital

Abstract

Non-reassuring fetal status (NRFS) encompasses a spectrum of feto-maternal conditions that causes hypoxia in utero and commonly presents as abnormal fetal heart rate and meconium-stained liquor, these abnormal changes are leading indicators for emergency cesarean sections (EMCS). In 2021 NRFS accounted for 36.03% of cesarean sections (CS) done at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH). Research is recommended to provide better knowledge base to guide decision regarding CS and to encourage policy changes. The broad objective was to determine the fetal outcome in cesarean deliveries for NRFS at JOOTRH. The specific objectives were to assess the immediate consequence of non-reassuring fetal heart rate on fetal outcome among mothers in labor at JOOTRH. To evaluate the decision to delivery interval (DDI) on fetal outcome among mothers with Non-Reassuring Fetal Heart rate who underwent emergency CS at JOOTRH. To determine the significance of meconium stain liquor (MSL) on fetal outcome among mothers who underwent emergency CS at JOOTRH. This was an institutional-based retrospective cross-sectional study, simple random selection was used to select files from January, 2020 to December, 2022. Fisher’s formulae was used to calculate the desired sample size of 191 patient files. Statistical Package for Social Sciences (SPSS) version 25, Chicago IL was used to analyze quantitative data. Both descriptive and inferential statistics was used to analyze the three specific objectives. Chi-square test was used to determine the association between the following dependent variables; APGAR score at 1 and 5 minutes, new born unit admission, resuscitation and fetal demise by the following independent variables; bradycardia, tachycardia and meconium stain liquor. It was also used to evaluate the mediator variable decision to delivery interval on fetal outcome among mothers with NRFHR who underwent emergency CS at JOOTRH. The study found that NRFHR had significant association with the APGAR score at 1 minute with a P value of <0.0001, APGAR score at 5 minutes with a P value of 0.002 and Neonatal demise with a P value of 0.001. DDI had a significant association with APGAR score at 5 minutes with a P value of 0.005 and Neonatal demise with a P value of <0.0001, There was no statistically significant difference in the other fetal outcomes. Only 1 (0.5%) emergency cesarean section was done under 30 minutes. MSL was found to have no significant association with the fetal outcomes. In conclusion, bradycardia was associated with poor neonatal outcomes, the average DDI is longer than the recommended target and MSL was not associated with poor fetal outcomes. We therefore recommend expediated interventions in all cases with fetal bradycardia and a review of the factors contributing to DDI with a view of reducing the waiting time.