title: Newborn outcomes in british columbia after caesarean section for non-reassuring fetal status.
abstract: OBJECTIVE
  To assess the incidence in British Columbia of severe morbidity in neonates delivered by Caesarean section for non-reassuring fetal status, and to examine the accuracy of Apgar score and umbilical cord gas values in predicting severe neonatal morbidity.
  
  
  METHODS
  We assessed rates of hypoxic ischemic encephalopathy, NICU admission, and ventilator days, individually and as a composite outcome with neonatal death, among a total of 8466 term singletons delivered by Caesarean section for non-reassuring fetal status between January 1, 2007, and December 31, 2011. We calculated the predictive accuracy of Apgar scores and umbilical cord blood gas values using the area under the receiver operating characteristic (ROC) curve and the sensitivity and specificity for each outcome.
  
  
  RESULTS
  The incidence of Apgar score at one minute < 4 was 8.0%, and for Apgar score at five minutes < 4 it was 0.6%. The incidence of umbilical cord pH < 7.10 was 6.5%, and for base-excess < -12 it was 2.9%. Apgar score at one minute < 7 had the greatest predictive accuracy for the composite outcome (81% for both sensitivity and specificity). The area under the ROC curve for Apgar score at one minute and at five minutes, umbilical cord pH, and base-excess was 0.87, 0.86, 0.76, and 0.78, respectively.
  
  
  CONCLUSIONS
  The incidence of abnormal Apgar score and abnormal umbilical cord gas values is very low among neonates in British Columbia delivered by Caesarean section for non-reassuring fetal status. Apgar score at one minute < 7 is a good predictor of severe neonatal morbidity. Electronic fetal monitoring remains a non-specific method for detection of fetal compromise in the intrapartum period.
authors.affiliation: Radboud University Nijmegen Medical Centre, Institute for Health Sciences, Nijmegen, The Netherlands; School of Population and Public Health, University of British Columbia, Vancouver BC.
authors.forename: Kevin
authors.initials: K
authors.lastname: Jenniskens
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver BC; Child and Family Research Institute, Vancouver BC.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Janssen
mesh_terms: D000328:Adult; D001034:Apgar Score; D001955:British Columbia / Q000453:epidemiology; D015148:Cardiotocography; D002585:Cesarean Section; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D005316:Fetal Distress / Q000601:surgery*; D005333:Fetus; D006801:Humans; D006863:Hydrogen-Ion Concentration; D020925:Hypoxia-Ischemia, Brain / Q000453:epidemiology; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D011247:Pregnancy; D012372:ROC Curve; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
keywords: Caesarean section; apgar score; fetal distress; sensitivity; specificity; umbilical cord blood