title: Caesarean Section for Foetal Distress and Correlation with Perinatal Outcome.
abstract: BACKGROUND
  The main documented indication of intrapartum caesarean section is foetal distress (MacKenzie and Cooke in BMJ 323(7318):930, 2001). Foetal distress indicates foetal hypoxia and acidosis during intrauterine life.
  
  
  OBJECTIVE
  To correlate the diagnosis of foetal distress and perinatal outcome.
  
  
  METHODS
  This was a prospective observational study of women who underwent caesarean section for foetal distress as detected by cardiotocography and not responding to intrauterine resuscitation. The foetal Apgar score at 1 and 5 min was recorded and cord blood pH was measured in all cases. The neonatal outcome was studied with regard to the need for supportive ventilation and admission to NICU/nursery.
  
  
  RESULTS
  In our study, 14.38 % cases diagnosed with foetal distress subsequently had poor outcome. Twenty-one babies had a 5-min Apgar score <7, required immediate resuscitation and were admitted in NICU. Twelve foetuses had a 1-min Apgar score <4, while there were three cases of severe birth asphyxia (Apgar score <4 at 5 min); of these, two babies died. The neonatal outcome was poorer in cases with associated complicating factors.
  
  
  CONCLUSIONS
  The diagnosis of foetal distress is imprecise and a poor predictor of foetal outcome-the result is a tendency for unnecessary caesarean sections. On the contrary, lack of adverse outcome could reflect that our unit makes decisions at a time before clinically significant foetal compromise occurs.
authors.affiliation: Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India.
authors.forename: Richa
authors.initials: R
authors.lastname: Gangwar
authors.affiliation: Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India.
authors.forename: Sarita
authors.initials: S
authors.lastname: Chaudhary
keywords: Caesarean section; Cardiotocography; Foetal distress; Perinatal outcome