Outcome predictors for patients delivered by cesarean section for fetal distress

Abstract

Objective: To determine predictive variables identifying infants admitted to neonatal intensive care (NIC) following cesarean section for fetal distress in labor at term. Methods: Two hundred eight patients were studied. Sixty-six patients delivered by cesarean section at term for fetal distress were compared to 142 term patients not diagnosed as fetal distress. The outcome indicator was admission to NIC. Patients diagnosed as fetal distress were studied to determine variables that increased prediction of adverse outcome. Variables studied were patient age, induction of labor, augmentation of labor, epidural anesthesia, birth weight, antepartum complications, and intrapartum complications. Comparisons were by Fishers Exact text and logistic regression. Results: Twenty-six infants were admitted to NIC. Eleven had a diagnosis of fetal distress and 21 had a diagnosis of antepartum complications. Fetal distress was not associated with admission to NIC ( P = .26) and had a low sensitivity (42%) and positive predictive value (17%). Antepartum complications, intrapartum complications, and birth weight were associated with admission to NIC ( P = .00001) ( P = .04) ( P = .05). Antepartum complications had a sensitivity of 81% and a positive predictive value of 33% for admission to NIC. The presence of both fetal distress and antepartum complications increased the positive predictive value to 91%. Only one infant was admitted to NIC with a diagnosis of fetal distress without antepartum complications. Positive predictive value 2.4%, negative predictive value 96%. Birth weight when dichotomized at the 5th percentile (2,606 g) had a sensitivity of 20% and a positive predictive value of 50% for admission to NIC. Five of 10 infants with a birth weight below the 5% percentile were admitted to NIC. Conclusion: Antepartum complications coupled with fetal distress in labor are a strong predictor of adverse outcome, which is not altered by cesarean section. There are two groups of patients with fetal distress in labor at term, and the group with antepartum complications or subtle reduction in birth weight are at extreme risk for adverse outcome. It appears that cesarean section for fetal distress may rescue infants without antepartum problems but may not rescue those with a challenging antepartum course, lending credence to the feeling that fetal distress in labor may be an indicator of prior stress in many patients.