The Job of the Obstetrician Does Not End by the Delivery of the Fetus With Non-reassuring Status [38O

Abstract

INTRODUCTION: Research generally focuses on neonatal outcomes when pregnancy is complicated by non-reassuring fetal status. Little attention has been directed to maternal outcomes after such deliveries. METHODS: A retrospective cohort study of 27,886 pregnancies at a single health system evaluated fetal status and postpartum maternal characteristics. Fetal heart tracing, arterial cord pH, maternal blood transfusion, and maternal ICU admission were among the evaluated characteristics. Multivariate logistic regression analyses were performed to assess correlation with markers of fetal well-being and maternal outcomes and adjusted odds ratios (AOR) were derived. RESULTS: Umbilical artery pH less than 7.0 was associated with transfusion (AOR 6.83 [95% CI 2.22–21.0, P<.001]), cesarean delivery (AOR 5.76 [95% CI 3.63–9.15, P<.0001]), and maternal readmission (AOR 12.6 [95% CI 2.26–69.8, P=.0039]). Fetal bradycardia events were associated with increased maternal ICU admission (AOR 3.22 [95% CI 1.23–8.46, P<.017]), transfusion (AOR 2.13 [95% CI 1.26–3.59, P<.005]) and readmission (AOR 4.17 [95% CI 1.16–15.0, P<.029]). Late decelerations were associated with cesarean delivery (AOR 1.65 [95% CI 1.55–1.76, P<.0001]), maternal readmission (AOR 1.24 [95% CI 1.01–1.53, P=.04]), chorioamnionitis (AOR 2.88 [95% CI 2.46–3.37, P<.0001]), and maternal need for antibiotics (AOR 1.89 [95% CI 1.66–2.15, P<.0001]). CONCLUSION: Non-reassuring fetal status is associated with significant risks to the mother as evidenced by significant increases in transfusions, ICU admissions, and readmissions. Obstetricians should remain vigilant after delivery for non-reassuring fetal status and focus on monitoring and optimization of maternal status.