Fetal distress, options of anesthesia, and immediate postdelivery outcome at state specialist hospital Akure

Abstract

Background: When abnormalities of the fetal heart rate are recognized promptly and dealt with, asphyxia and therefore perinatal morbidity and mortality can be reduced. The objective of fetal monitoring during labor is the prediction and diagnosis of fetal asphyxia before fetal/newborn morbidity with particular reference to brain damage occurs. Fetal distress is one of the conditions in which the obstetrician is required to hasten the process of delivery. This urgency is also usually transferred to the anesthetists, whereas the burden of adverse fetal outcome falls squarely on the pediatrician. Objective: This study found out the form of anesthesia mostly used for caesarean sections (CS) in cases of fetal distress, its appropriateness in terms of achieving management goals, and advantages over the other form of anesthesia. Study Design: This study is a retrospective descriptive cross-sectional study. Materials and Methods: Records of patients that had caesarean section for suspected fetal distress over a period of 5 years were reviewed. The fetal status at the point of making diagnosis, type of anesthesia used, suite-arrival-incision-interval, and the baby's condition after surgery were retrieved from the case notes. Data were analyzed with the Statistical Package for Social Sciences (SPSS) version 20.0. Frequencies and proportions of data from the type-of-anesthesia groups were compared. Variables were compared for significance using Chi-square. Results: Most of the surgeries for fetal distress were done under spinal anesthesia in 90% of the patients. Suite arrival-to-incision interval which is largely affected by type of anesthesia was within 1 h 30 min in 91.6% of those that had spinal anesthesia compared to 100% for those that had general anesthesia (GA). P value = 0.000. APGAR score of <4 was more in neonates delivered with GA (61.1%) than those delivered with spinal anesthesia (14.5%). Percentage of neonatal admission into special care baby unit (SCBU) was more in those that had GA (85%) than those that had spinal anesthesia (14%). Conclusion: The predominant type of anesthesia used for caesarean section for fetal distress from this study was spinal anesthesia which had better neonatal outcome.