Pregnancy outcome and placental pathology in emergent cesarean deliveries for non-reassuring fetal heart rate in laboring versus non-laboring women.

OBJECTIVE

The objective of this study is to correlate between pregnancy outcome and placental pathology in emergent cesarean deliveries (ECD) for non-reassuring-fetal-heart-rate (NRFHR) performed in women in their active phase of labor versus those performed in non-laboring women.

METHODS

A retrospective cohort study. Data were reviewed for all pregnancies necessitating ECD for NRFHR between January 2009 and December 2013. Maternal outcome, neonatal outcome, and placental pathology parameters were compared between ECDs performed during active phase of labor and those performed before the active phase of labor (non-labor group).

RESULTS

During the study period, a total of 661 ECDs were performed due to NRFHR. Compared with the active labor group (n = 335), the non-labor group (n = 326) had more pre-eclampsia (p = 0.033), small for gestational age (SGA) (p = 0.016), and preterm labor (p < 0.001). Worse composite neonatal outcome was observed in the non-labor group compared with the active labor group, p < 0.001. By a stepwise logistic regression model, non-labor was independently associated with adverse neonatal outcome (1.88 OR CI; 1.19-2.96, p = 0.007). Placental inflammatory lesions were more common in the active labor group (p= 0.043), and abnormal cord insertions were more common in the non-labor group (p = 0.002) as well as placental weight <10th% (p = 0.019).

CONCLUSION

Higher rate of pregnancy complications, abnormal cord insertion, smaller placentas, and worse neonatal outcome are associated with ECD for NRFHR when performed before the phase of active labor.