Fetal cardiotocography and acid-base status during cesarean section.
OBJECTIVE
To assess the fetal well-being during cesarean section, in relation to the previous fetal condition.


METHODS
Observational study.


METHODS
University Hospital. PATIENTS PARTICIPANTS: 204 women undergoing cesarean section (203 intrapartum cesarean sections): 177 with general anesthesia and 27 with spinal anesthesia.


METHODS
We compared the fetal heart records of the last 30 min before cesarean section (during the first stage of labor) with those during cesarean section. Scalp blood analysis 30 min before the beginning of anesthesia induction was compared with umbilical artery analysis at delivery.


METHODS
Cardiotocography. Acid-base analysis. Apgar scores.


RESULTS
During cesarean section there was a reduction in uterine activity, an increase in silent tracings and a decrease in late decelerations. Umbilical artery pH was lower than scalp pH (7.23+/-0.06 vs 7.30+/-0.06). Oxygen saturation was also lower (14.43+/-8.58% vs 18.99+/-8.4%). The values of pCO2 and of base deficit were higher. During cesarean section low values of modified Fischer scores were associated with low pH values of umbilical artery and low Apgar scores.


CONCLUSIONS
Silent tracings appearing during cesarean section usually do not indicate fetal distress. Poor intracesarean fetal heart tracings were associated with worse indicators of neonatal well-being. Although umbilical pH were lower than scalp values, when the correction described in the literature was applied, the difference was of little clinical relevance. It is concluded that anesthesic, pharmacological and surgical events have slight repercussion in fetal well being. However, in a few cases fetal heart monitoring during cesarean section could detect otherwise undiagnosed cases of transient acidemia or depression in the fetus.
Matorras
R
R
Department of Obstetrics and Gynecology, Hospital from Cruces, Baracaldo, Vizcaya, Spain.
Tacuri
C
C
Nieto
A
A
Pijoan
J I
JI
Cortés
J
J
D000136:Acid-Base Equilibrium; D000758:Anesthesia; D001769:Blood; D015148:Cardiotocography; D002585:Cesarean Section; D005260:Female; D005333:Fetus / Q000502:physiology*; D006340:Heart Rate, Fetal; D006801:Humans; D006863:Hydrogen-Ion Concentration; D011247:Pregnancy; D012535:Scalp / Q000098:blood supply; D014469:Umbilical Arteries; D014590:Uterine Contraction