Cesarean delivery for suspected fetal distress among preterm parturients

OBJECTIVE: Among preterm parturients (< 37 weeks) who underwent cesarean de livery for suspect ed fetal distress, to determine the factors associated w ith decision-incision time (DIT) of less than or equal to 30 minutes and to assess if umbilical arterial pH < 7.10 is move common with DIT less than o r equal to 30 or > 30 minutes. STUDY DESIGN: The peripartum course of all patients who had cesareans for s uspected fetal distress over three years was reviewed. The inclusion criter ia were reliable gestational age < 37 weeks and a single indication for ces arean delivery, suspected fetal distress. Twenty antepartum and intrapartum factors were used in a univariate analysis. RESULTS: The mean DIT among the 84 parturients was 30.5 +/- 21.2 minutes, a nd 63% of patients had surgery started within 30 minutes. The incidence of pH < 7.10 was 20%. Multivariate analysis indicated that the two factors sig nificantly associated with prolonged time to surgery were tachycardia with decreased variability (odds ratio [OR] 5.9, 95% confidence interval [CI] 1. 6-21.6) and use of spinal anesthesia (OR 6.2, 95% CI 1.1-35.0). Though none of the 20 variables had significant the univariate associations with neona tal acidosis at alpha=.05, those with P<.20 were considered in multiple log istic regression analysis. None of the 20 factors were associated with pH < 7.10, including DIT of 30 minutes (OX 0.26 95% CI 0.06-1.03). CONCLUSION: DIT is likely to be >30 minutes if cesarean delivery is due to decreased fetal heart variability or if spinal anesthesia is utilized; neon atal acidosis, however is not significantly associated with a prolonged int erval.