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Justified indicators for caesarean section in fetal distress
Introduction. The number of caesarean sections (CSs) carried out is rising worldwide, with one of the main fetal indicators for this method of delivery being fetal distress. In our department, the rate is reported to be particularly high compared with the literature. Our decision to perform a CS delivery during labour is based only on the cardiotocograph (CTG) recording, and so the aim of this study was to carry out an audit of CSs in fetal distress with a view to analysing this criterion, and to link the CTG findings that diagnose fetal distress to fetal outcome in order to assess the accuracy of the diagnosis.
Methods. This is a retrospective and descriptive study of cases, using files, delivery book and electronic medical records which were collected over a period of 6 months. Some relevant clinical data were collected and used to measure clinical distress in the fetus. Some of the results relating to CS incidence and CTG recording have been compared with the literature. The major factors leading to emergency CSs were identified. Decision to delivery time and neonatal outcome were assessed based on Apgar score, cord pH and neonatal intensive care admission.
Results. There were 1890 deliveries during the study period, i.e. 1 June 2011 to 31 December 2011. Of these, 101 women underwent CSs due to fetal distress, with 90 (17.4% of total CSs) included in the study. The remaining 11 women were excluded as they did not meet study criteria. The main indicators for CSs were CTG-recording abnormalities and meconium-stained liquor. One of the major points to emerge was that despite women having been taken for an emergency CS as a result of fetal distress, analysis of the fetal outcome showed that not one of the newborns had low Apgar score (< 7) at 5 minutes.
Conclusion. The high rate of CSs for fetal distress in our department is probably due to a lack of other surveillance methods such as fetal scalp blood sampling and integrated CTG recording and fetal electrocardiography, but it is also symptomatic of the fear of medicolegal issues.