198 Cesarean delivery for non-reassuring fetal heart rate tracing: risk factors and predictability of adverse outcomes

Abstract

Non-reassuring fetal heart rate tracing (NRFHT) is a common driver of cesarean delivery (CD) but data is lacking to predict composite neonatal and maternal adverse outcomes (CNAO and CMAO, respectively). The primary objectives were to identify risk factors for CNAO and CMAO among those who underwent CD for NRFHT and explore predictive models. We conducted a secondary analysis of the Consortium on Safe Labor Database. Eligible subjects included persons with non-anomalous singleton gestations between 37.0 and 41.6 weeks who had CD for NRFHT. Pre-CD variables from the database were used to develop a model to identify those with and without adverse outcomes. Bivariable analysis and multivariable Poisson regression with robust error variance were used to identify independent risk factors. Receiver operating characteristic (ROC) curves were created to evaluate the predictive value of the models for adverse outcomes. Of the 228,438 births, 7,310 (3.7%) met eligibility criteria. Adverse composite outcomes occurred in 3.8% of newborns and 3.4% of mothers following CD for NRFHT. Neonatal sepsis (45%) and the need for intubation (26%) were the most common drivers of CNAO while CMAO was most often due to need for transfusion (39%) and endometritis (31%). 10 maternal characteristics and 17 intrapartum variables were analyzed in bivariable analysis. Three maternal and three intrapartum risk factors were identified for CNAO (AUC=0.62; Table 1). Three maternal and four intrapartum risk factors were identified for CMAO (AUC=0.66; Table 2). For both groups the single most predictive driver of adverse outcome was chorioamnionitis. Neonatal sepsis (45%) and the need for intubation (26%) were the most common drivers of CNAO while CMAO was most often due to need for transfusion (39%) and endometritis (31%). NRFHT was the indication for CD in ∼ 4% of term deliveries and ∼4% have CNAO or CMAO. Though certain demographic and intrapartum factors increase the risk of adverse outcomes they are not clinically useful to predict who will experience them.View Large Image Figure ViewerDownload Hi-res image Download (PPT)