Fetal distress, interventions and newborn outcomes at a National Referral Hospital in Kampala Uganda: A retrospective study

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Background: Fetal distress, also known as non-reassuring fetal status, is a major contributor to poor newborn outcomes before and after birth. This study examined the clinical diagnosis of fetal distress and the newborn outcomes in a three-month cohort of women. Methods: This was a retrospective cohort study where 5404 maternity case records of women who gave birth at Kawempe National Referral Hospital during June to August 2019 were reviewed. Data were collected by trained nurse/midwives from the records using a checklist designed in Kobo Collect software. The data were exported to Stata 14 for cleaning and analysis. The prevalence of fetal distress was calculated as a percentage of those with a diagnosis out of the total number of records. All other data were summarized descriptively, and chi-square tests were computed to assess the association between fetal distress and newborn outcomes. Results: The prevalence of fetal distress was 257/4799 (5.4%), and of these, 51.3% had an abnormal fetal heart rate < 120b/min or > 160b/min. Meconium-stained amniotic fluid was present in 65% of all women diagnosed with fetal distress. Interventions for fetal distress during labour were mainly: administration of intravenous fluids (28.8%), monitoring of the fetal heart rate (10.5%), and lateral positioning (4.3%). An emergency cesarean section was the most common mode of birth planned for women with fetal distress (90.7%), although eventually, only 76.7% delivered by cesarean section. Women with fetal distress were more likely (12.5%, p<0.001) to have newborns with low Apgar scores <7 at 5 minutes. Conclusion: Fetal distress occurred in 5.4% of case records reviewed, with the majority undergoing a cesarean section birth. Despite the interventions such as intravenous fluid infusion, FHR monitoring, and lateral positioning, poor outcomes were observed more in those with fetal distress than in those without.

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