Urgent Cesarean Delivery for Fetal Bradycardia

Leung, Tak Yeung; Chung, Pui Wah; Rogers, Michael S.; Sahota, Daljit Singh; Lao, Terence T.; Chung, Tony K.H.

doi:10.1097/01.aoa.0000393170.93403.28

Cited by 7 publications

(20 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although the risks of hypoxic ischaemic encephalopathy (HIE) and neonatal mortality were different between groups I and III, the wide confidence intervals for the risk ratio suggests some imprecision. Our findings corroborate those of previous publications 31,36 that reported that the rate of neonatal acidosis is linked with indications for emergency delivery. Future studies should discern the factors that significantly ameliorate the risk of neonatal morbidity with emergent caesarean.…”

Section: Principal Findingssupporting

confidence: 93%

Indications for caesarean sections at ≥34 weeks among nulliparous women and differential composite maternal and neonatal morbidity

Chauhan

Beydoun

Hammad

et al. 2014

BJOG

View full text Add to dashboard Cite

Objective To compare composite maternal and neonatal morbidities (CMM, CNM) among nulliparous women with primary indications for caesarean section (CS) as acute clinical emergency (group I; ACE), non-reassuring fetal heart rate (group II) and arrest disorder (group III).Design A multicentre prospective study.Setting Nineteen academic centres in the USA, with deliveries in 1999-2002.Population Nulliparous women (n = 9829) that had CS.Methods Nulliparous women undergoing CS for three categories of indications were compared using logistic regression model, adjusted for five variables.Main outcome measures CMM was defined as the presence of any of the following: intrapartum or postpartum transfusion, uterine rupture, hysterectomy, cystotomy, ureteral or bowel injury or death; CNM was defined as the presence of any of the following: umbilical arterial pH <7.00, neonatal seizure, cardiac, hepatic, renal dysfunction, hypoxic ischaemic encephalopathy or neonatal death.Results The primary reasons for CS were ACE in 1% (group I, n = 114) non-reassuring FHR in 29% (group II; n = 2822) and failed induction/dystocia in the remaining 70% (group III; n = 6893). The overall risks of CMM and CNM were 2.5% (95% confidence intervals, CI, 2.2-2.8%) and 1.9% (95% CI 1.7-2.2), respectively. The risk of CMM was higher in group I than in group II (RR 4.1, 95% CI 3.1, 5.3), and group III (RR 3.2, 95% CI 2.7, 3.7). The risk of CNM was also higher in group I than in group II (RR 2.8, 95% CI 2.3, 3.4) and group III (RR 14.1, 95% CI 10.7, 18.7).Conclusions Nulliparous women who have acute clinically emergent caesarean sections are at the highest risks of both composite maternal and neonatal morbidity and mortality.

show abstract

Section: Principal Findingssupporting

confidence: 93%

Indications for caesarean sections at ≥34 weeks among nulliparous women and differential composite maternal and neonatal morbidity

Chauhan

Beydoun

Hammad

et al. 2014

BJOG

View full text Add to dashboard Cite

show abstract

“…Although our result shows a slower rate of decline in pH than that estimated by Wood et al, 9 our value was similar to the rate of 0.01 per minute decline in pH reported in cases of placental abruption and cord prolapse. 13 This rate is faster than that in the case of vaginal twin delivery, in which the rate of decline in cord arterial pH of the second twin was 0.0046 per minute after the first twin's delivery. 14,15 Our observation suggests that the likelihood of developing severe acidosis (pH < 7) within an HBDI of 5 minutes is relatively low, as only 0.5% of our Art., arterial; AS5, Apgar score at 5 minutes; BE, base excess; DM, diabetes; HBDI, head-to-body interval; Ven., venous.…”

Section: Discussionmentioning

confidence: 76%

Head-to-body delivery interval and risk of fetal acidosis and hypoxic ischaemic encephalopathy in shoulder dystocia: a retrospective review

Leung

Stuart

Sahota

et al. 2010

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

119

View full text Add to dashboard Cite

Objective To examine the association between head-to-body delivery interval (HBDI) and cord arterial pH and base excess (BE), and the risk of development of hypoxic ischaemic encephalopathy (HIE). Design Retrospective review.Setting A university hospital.Population Pregnancies complicated with shoulder dystocia during the period 1995-2009.Methods Cases were identified from a search of the hospital electronic delivery records. Cord arterial pH and BE, and the incidence of HIE and perinatal death, were retrieved from medical records and correlated with HBDI, birth weight, mode of delivery and presence of nonreassuring fetal heart rate pattern and maternal diabetes using univariate analysis, followed by multivariate analysis.Main outcome measures Any association between cord pH and HBDI.Results Of the 200 cases identified, the mean (standard deviation) HBDI was 2.5 minutes (1.5 minutes). Both HBDI and the presence of nonreassuring fetal heart rate pattern were independent factors for pH, and HBDI was the only significant factor for BE. Arterial pH dropped at a rate of 0.011 per minute [95% confidence interval (95% CI), 0.017-0.004; P = 0.002] with HBDI. The mode of delivery, birth weight and maternal diabetes did not affect blood gas levels. The respective risks of severe acidosis (pH < 7) and HIE with HBDI of <5 minutes were 0.5% and 0.5% versus 5.9% and 23.5% with HBDI ‡ 5 minutes.Conclusions Cord arterial pH drops with HBDI during shoulder dystocia, but the risk of acidosis or HIE is very low with HBDI < 5 minutes.Keywords Acidosis, base excess, head-to-body delivery interval, hypoxic ischaemic encephalopathy, shoulder dystocia, umbilical cord pH.

show abstract

“…16 This paradoxical phenomenon was also demonstrated in Group 2, and likely resulted from a selection bias, in which the severe cases with poorer outcome were delivered urgently, whereas mild cases with good outcome tended to be delivered less urgently. 17,18 Only when we analyzed according to different fetal heart rate patterns and defined the time period from the onset of bradycardia, was the correlation revealed.…”

Section: Discussionmentioning

confidence: 99%

“…Cord arterial pH drops at 0.009 per minute, which is similar to our previously reported rate of 0.011 per minute in other irreversible causes such as abruptio placentae and shoulder dystocia. 18,34 Hence, a decision-to-delivery interval of less than 15 minutes (or bradycardia-to-delivery interval of less than 20 minutes)…”

Section: Discussionmentioning

confidence: 99%

“…17 We have previously shown that the cord arterial pH and base excess deteriorate rapidly with bradycardia-to-delivery interval and do not correlate with decision-to-delivery interval, in cases where fetal distress was due to a group of irreversible pathologies, including placental abruption, uterine rupture, cord prolapse, preeclampsia, and failed instrumental delivery. 18 Yet, the number of cases with cord prolapse in the previous study was limited. Further, there is a paucity of literature reporting on the relation between the perinatal outcomes and fetal heart rate patterns other than bradycardia in the event of cord prolapse.…”

Section: Introductionmentioning

confidence: 93%

See 1 more Smart Citation

Bradycardia‐to‐delivery interval and fetal outcomes in umbilical cord prolapse

Wong

Tse

Lai

et al. 2020

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

Introduction Umbilical cord prolapse is a major obstetric emergency associated with significant perinatal complications. However, there is no consensus on the optimal decision‐to‐delivery interval, as many previous studies have shown poor correlation between the interval and umbilical cord arterial blood gas or perinatal outcomes. We aim to investigate whether bradycardia‐to‐delivery or decision‐to‐delivery interval was related to poor cord arterial pH or adverse perinatal outcome in umbilical cord prolapse. Material and methods This was a retrospective study conducted at a university tertiary obstetric unit in Hong Kong. All women with singleton pregnancy complicated by cord prolapse during labor between 1995 and 2018 were included. Women were categorized into three groups. Group 1: persistent bradycardia; Group 2: any type of decelerations without bradycardia; and Group 3: normal fetal heart rate. The main outcome was cord arterial blood gas results of the newborns in different groups. Maternal demographic data and perinatal outcomes were reviewed. Correlation analysis between cord arterial blood gas result and time intervals including bradycardia‐to‐delivery, deceleration‐to‐delivery, and decision‐to‐delivery were performed for the different groups with Spearman test. Results There were 34, 30, and 50 women in Groups 1, 2, and 3, respectively. Cord arterial pH and base excess did not correlate with decision‐to‐delivery interval in any of the groups, but they were inversely correlated with bradycardia‐to‐delivery interval in Group 1 (Spearman’s ρ = −.349; P = .043 and Spearman's ρ = −.558; P = .001, respectively). The cord arterial pH drops at 0.009 per minute with bradycardia‐to‐delivery interval in Group 1 (95% CI 0.0180‐0.0003). The risk of significant acidosis (pH < 7) was 80% when bradycardia‐to‐delivery interval was >20 minutes, and 17.2% when the interval was <20 minutes. Conclusions There is significant correlation between bradycardia‐to‐delivery interval and cord arterial pH in umbilical cord prolapse with fetal bradycardia but not in cases with decelerations or normal heart rate. The drop of cord arterial pH is rapid and urgent delivery is essential in such situations.

show abstract

Urgent Cesarean Delivery for Fetal Bradycardia

Cited by 7 publications

References 0 publications

Indications for caesarean sections at ≥34 weeks among nulliparous women and differential composite maternal and neonatal morbidity

Indications for caesarean sections at ≥34 weeks among nulliparous women and differential composite maternal and neonatal morbidity

Head-to-body delivery interval and risk of fetal acidosis and hypoxic ischaemic encephalopathy in shoulder dystocia: a retrospective review

Bradycardia‐to‐delivery interval and fetal outcomes in umbilical cord prolapse

Contact Info

Product

Resources

About