Accuracy of Clinical Diagnosis of Fetal Distress
AbstractBackground: Fetal distress has significantly contributed to the rising caesarean section rate, which is as high as 20?25%. Caesarean section for clinically diagnosed fetal distress has been criticized as being unjustified in many instances.
Objectives: To assess the fetal outcome in women delivered by caesarean section following a clinical diagnosis of fetal distress and to determine the accuracy of this diagnosis.
Methods: A retrospective analysis of the case notes of 126 parturients delivered by caesarean section for clinically diagnosed fetal distress at the University of Nigeria Teaching Hospital (UNTH) Enugu over a two?year period.
Results: Forty six (36.5%) babies had Apgar scores of 7 and above, while 80(63.5%) had Apgar scores lower than 7, including 5 (4.0%) fresh stillbirths. The caesarean section rate in the hospital during the period covered by this study was 19.9% and fetal distress contributed 2.3% of this rate. The perinatal mortality rate was 39. 7 per 1000.
Conclusion: Clinical diagnosis of fetal distress is accurate in about two?thirds of cases and wrong in the remaining one?third. Electronic fetal heart monitoring, fetal scalp blood sampling and fetal pulse oximetry should be provided by health care managers to improve diagnosis of fetal distress and minimize unnecessary caesarean sections. Though this study demonstrates the limitations of using clinical parameters alone in the diagnosis of fetal distress and in the selection of cases for caesarean section; however, in the absence of such modem facilities, clinical diagnosis is still useful, otherwise about two?thirds of such babies might perish.
Key Words: Caesarean section, Fetal distress, Clinical diagnosis.
Journal of College of Medicine Vol.9(1) 2004: 12-13