title: Refusal of emergency caesarean delivery in cases of non-reassuring fetal heart rate is an independent risk factor for perinatal mortality.
abstract: OBJECTIVE
  To assess pregnancy outcome in women who initially refused medically indicated caesarean delivery (CD) in cases of non-reassuring fetal heart rate (FHR) patterns.
  
  
  METHODS
  A retrospective cohort study, comparing patients who refused and did not refuse caesarean delivery (CD) due to non-reassuring FHR tracings, was conducted. Deliveries occurred between the years 1988 and 2009 in a tertiary medical center. Multivariate analysis was performed to control for confounders.
  
  
  RESULTS
  Out of 10,944 women who were advised to undergo CD due to non-reassuring FHR patterns, 203 women initially refused CD. Women refusing medical intervention tended to be older (30.6 ± 6.9 vs. 28.29 ± 6.1, P<0.001) and of higher parity (46.8% vs. 19.9% had more than 5 deliveries; P<0.001) as compared to the comparison group. Refusal of CD was significantly associated with adverse perinatal outcome. Using a multiple logistic regression model controlling for confounders such as maternal age, refusal of treatment was found as an independent risk factor for perinatal mortality (adjusted OR=3.3, C.I. 95% 1.8-5.9, P<0.001). A non-significant trend towards higher rates of adverse perinatal outcome was found when refusal latency time was longer than 20 min (OR=2, 95% CI 0.36-11.95; P=0.29).
  
  
  CONCLUSIONS
  Refusal of CD in cases of non-reassuring FHR tracings is an independent risk factor for perinatal mortality.
authors.affiliation: Faculty of Health Sciences, Joyce and Irving Goldman Medical School, Soroka University Medical Center, Ben Gurion University of the Negev, Be'er-Sheva, Israel.
authors.forename: Rachel
authors.initials: R
authors.lastname: Ribak
authors.forename: Avi
authors.initials: A
authors.lastname: Harlev
authors.forename: Iris
authors.initials: I
authors.lastname: Ohel
authors.forename: Ruslan
authors.initials: R
authors.lastname: Sergienko
authors.forename: Arnon
authors.initials: A
authors.lastname: Wiznitzer
authors.forename: Eyal
authors.initials: E
authors.lastname: Sheiner
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000523:psychology*; D005260:Female; D005316:Fetal Distress / Q000601:surgery*; D006340:Heart Rate, Fetal; D006801:Humans; D016015:Logistic Models; D054238:Perinatal Mortality; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D016312:Treatment Refusal; D055815:Young Adult