title: Evaluation of Clinical Diagnosis of Fetal Distress and Perinatal Outcome in a Low Resource Nigerian Setting.
abstract: BACKGROUND
  Fetal distress has been shown to contribute to the increasing caesarean section rate. There has been controversy on the usefulness of clinical diagnosis of fetal distress using only the intermittent counting of the fetal heart rate and/or passage of meconium-stained liquor.
  
  
  OBJECTIVE
  To evaluate the clinical diagnosis of fetal distress and the perinatal outcome.
  
  
  METHODS
  This was a retrospective study in which the case records of the patients, who were diagnosed of fetal distress at Federal Teaching Hospital, Abakaliki, Nigeria, from January 1, 2008 to December 31, 2014, were collated. The statistical analysis was done using the Statistical Package for Social Sciences version 17 software (SPSS Inc., Chicago IL, USA).
  
  
  RESULTS
  Out of the 15,640 deliveries carried out within the study period, 3,761 (24.05%) deliveries were through caesarean section. A total of 326 (8.9%) of the 3,761 caesarean sections were due to fetal distress within the study period. More so, a total of 227 (70.9%) babies were born with ≥ 7 Apgar score at the 1(st) minute of delivery. The perinatal mortality rate was 31.25 per 1000 deliveries. Though birth asphyxia was recorded more on babies of mothers that had fresh meconium-stained liquor and whose decision-intervention interval was more than 30 minutes when compared with those without any of the two conditions, there was no statistical significant difference between them.
  
  
  CONCLUSIONS
  The clinical diagnosis of fetal distress is accurate in 29.1% of the cases. However, it has led to an unnecessary caesarean section in the remaining 70.9% of the parturients. In order to reduce this high trend of unnecessary caesarean sections due to clinical diagnosis of fetal distress in this environment, antepartum fetal assessment with non-stress test or biophysical profile and intrapartum use of continuous electronic fetal monitoring should be used to confirm or refute the fetal distress before any surgical intervention. Fetal blood sampling and fetal pulse oximetry should be performed in event of non- re-assuring or abnormal cardiotocography.
authors.affiliation: Faculty, Department of Obstetrics and Gynaecology, Federal Teaching Hospital , Abakaliki, Nigeria .
authors.forename: Leonard Ogbonna
authors.initials: LO
authors.lastname: Ajah
authors.affiliation: Faculty, Department of Obstetrics and Gynaecology, Federal Teaching Hospital , Abakaliki, Nigeria .
authors.forename: Perpetus Chudi
authors.initials: PC
authors.lastname: Ibekwe
authors.affiliation: Faculty, Department of Obstetrics and Gynaecology, Federal Teaching Hospital , Abakaliki, Nigeria .
authors.forename: Fidelis Agwu
authors.initials: FA
authors.lastname: Onu
authors.affiliation: Faculty, Department of Paediatrics, Federal Teaching Hospital , Abakaliki, Nigeria .
authors.forename: Ogah Emeka
authors.initials: OE
authors.lastname: Onwe
authors.affiliation: Faculty, Department of Paediatrics, Federal Teaching Hospital , Abakaliki, Nigeria .
authors.forename: Thecla Chinonyelum
authors.initials: TC
authors.lastname: Ezeonu
authors.affiliation: Faculty, Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital , Enugu, Nigeria .
authors.forename: Innocent
authors.initials: I
authors.lastname: Omeje
keywords: Apgar score; Intrapartum fetal monitoring; Nigeria; Poor setting