Abstract

Primary Caesarean section rates are on a rise in day to day obstetric practice. Non-Reassuring Fetal Status(NRFS) is a common indication for emergency Caesarean delivery (CD) in 1st stage of labor. The aim of this study was to evaluate NRFS cases in 1st stage of labor leading to emergency caesarean & analyze the association of NRFS with intra-operative findings, and perinatal outcome. Methods: A retrospective observational study was conducted in the department of Obstetrics & Gynecology at PES Institute of Medical Sciences and Research, Kuppam. All necessary data were collected from 160 case records of pregnant women who underwent emergency caesarean in 1st stage of labor for NRFS, during the period July 2018 to June 2019. Cardiotocography (CTG) interpretation & NRFS categorization was done according to the FIGO consensus guidelines on intrapartum fetal monitoring CTG tracing classifications (2015). Statistical analysis was carried out by Chi-square test for qualitative variables to find the association & the level of significance was set at P value <0.05. Results: In the NRFS pattern noted, total 53.12% (85) decelerations were seen. 22.5% (36) traces showed type 2 decelerations, 13.75% (22) were detected with prolonged deceleration, 16.87% (27) tracings had variable deceleration. Pathological baseline heart rate variations was significantly associated intra operative findings of MSAF (p<0.02). The presence of pathological CTG was associated with intraop liquor status & perinatal outcome (p value < 0.012). There were 34.38% NICU admissions out of 160 babies. 23.8% were admitted for observation, of which 18.3% babies showed Pathological CTG &28.1%babies showed suspicious intrapartum CTG. Statistically significant association was noted between gestational age and neonatal morbidity (p<0.001), predominantly birth asphyxia was prevalent at >40wks gestation. Birth asphyxia was noted in twelve babies (7.5%), of these 18.8% belonged to >40 wk gestation. Conclusions: CTG plays an important role in diagnosing NRFS necessitating timely obstetric intervention. NRFS, in the presence of MSAF is associated with increased perinatal morbidity & mortality. Nevertheless, minimizing inter-observer variability during interpretation of NRFS, along with a good clinical judgement & timely intervention optimizes perinatal outcomes

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