title: Intraoperative findings, placental assessment and neonatal outcome in emergent cesarean deliveries for non-reassuring fetal heart rate.
abstract: OBJECTIVE
  To correlate between intraoperative findings, placental histopathology and neonatal outcome in emergent cesarean deliveries (ECD) for non-reassuring fetal heart rate (NRFHR).
  
  
  METHODS
  Data on ECD for NRFHR were reviewed for labor, documented intraoperative findings, neonatal outcome parameters and placental histopathology reports. Results were compared between those with and without intraoperative findings. Placental lesions were classified to those related to maternal underperfusion or fetal thrombo-occlusive disease, and those related to maternal (MIR) and fetal (FIR) inflammatory responses. Neonatal outcome consisted of low Apgar score (≤7 at 5 min), cord blood pH<7.0, and evidence of respiratory distress, necrotizing enterocolitis, sepsis, transfusion, ventilation, seizure, hypoxic-ischemic encephalopathy, phototherapy, or death.
  
  
  RESULTS
  Intraoperative findings were observed in 49.5% of 543 women, mostly cord complications (77%). Placental lesions were more common in those without intraoperative findings as compared to those with intraoperative findings: placental lesions related to maternal under-perfusion, vascular lesions, 9.1% vs. 4.1%, p=0.024, and villous changes, 39.2% vs. 30.7%, p=0.047, lesions consistent with fetal thrombo-occlusive disease, 13.6% vs. 7.4%, p=0.024, and inflammatory lesions, MIR and FIR, p=0.033, p=0.001, respectively. By using multivariate logistic regression analysis, adverse neonatal outcome was found to be dependent on maternal age, gestational age, preeclampsia placental weight <10th%, and MIR.
  
  
  CONCLUSIONS
  NRFHR necessitating ECD may originate from different underlying mechanisms. In about half, the insult is probably acute and can be identified intraoperatively. In the remaining half, underlying placental compromise may be involved.
authors.affiliation: Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Beilinson Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: masolbarak@gmail.com.
authors.forename: Eran
authors.initials: E
authors.lastname: Weiner
authors.affiliation: Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Beilinson Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Bar
authors.affiliation: Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Beilinson Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Nataly
authors.initials: N
authors.lastname: Fainstein
authors.affiliation: Department of Pathology, The Edith Wolfson Medical Center, Holon, Beilinson Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Letizia
authors.initials: L
authors.lastname: Schreiber
authors.affiliation: Department of Obstetrics & Gynecology, Beilinson Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Avi
authors.initials: A
authors.lastname: Ben-Haroush
authors.affiliation: Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Beilinson Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Kovo
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D005316:Fetal Distress / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D006340:Heart Rate, Fetal; D006801:Humans; D010920:Placenta / Q000473:pathology*; D011247:Pregnancy; D012189:Retrospective Studies; D014470:Umbilical Cord; D055815:Young Adult
keywords: Emergent cesarean deliveries; Intraoperative findings; Neonatal outcome; Non-reassuring fetal heart rate; Placental histopathology