Immediate fatal outcomes of Caesarean sections done for fetal distress at term at University Teaching Hospital Lusaka Zambia

Abstract

Background: Fetal distress is a common indication for an emergency caesarean section (C/S). The term fetal distress refers to the presence of signs in a pregnant woman that suggests that the fetus may be compromised and this is manifest by fetal heart rate abnormalities and/or presence of fresh meconium. Delayed intervention can lead to fetal death or serious long term neurological sequelae. There is a paucity of information on fetal outcomes of caesarean sections done for fetal distress and this study is aimed to determine this at the University Teaching Hospital (UTH), Lusaka, Zambia.Methods: A cross sectional study documenting patient and pregnancy details, (including time interval from decision to C/S for fetal distress) and fetal outcomes. Data was collected by reviewing files of consenting patients with a term gestation (>37weeks) who had undergone C/S for fetal distress. Factors were stratified by fetal outcome (bad outcome= stillbirths and Apgar score at 5 minutes of <7). Chi square (or Fisher exact test) was used to test for association between factors and fetal outcome (unadjusted odds ratios). A multivariate logistic regression model was used to test for factors independently associated with a bad outcome, controlling for potential confounders (adjusted odds). Results: Between September 2013 and January 2014, 216 women were recruited in the study of which 182 (84.3%) of the babies had good outcome (5 minute Apgar score 7 or more) while the other 34 (15.7%) had a poor outcome. In univariate analysis, age, parity, referral status, and clinical diagnosis were not associated with fetal outcome. However, caesarean section under general anaesthesia (as opposed to spinal anaesthesia) was associated with a poor fetal outcome (unadjusted OR 3.28, 95% CI 1.5 to 7.18) as was delay of greater than 3 hours from decision to delivery by caesarean section (unadjusted OR 2.65, 95%CI 1.24 to 5.73). Multivariate logistic regression, controlling for confounding, showed that general anaesthesia and delay >3hrs remained independently associated with poor fetal outcome (adjusted ORs of 3.7 and 5.13 respectively). Conclusion: General anaesthesia and delay in doing C/S were important determinants of (poor) fetal outcome in C/S done for fetal distress. Attention needs to be paid in expediting C/S. Further studies are warranted to understand the reason general anaesthesia is detrimental to fetal outcome.