Clinical suspicion, management and outcome of intrapartum foetal distress in a public hospital with limited advanced foetal surveillance

Objectives: To determine the basis for the clinical suspicion of foetal distress, the instituted managements and delivery outcome in a tertiary hospital in sub-Saharan Africa with limited capability for advanced foetal monitoring. Methods: It is a 3-year retrospective analysis of all the obstetrics cases with intrapartum foetal distress. Results: There were 301 cases reviewed. The birth asphyxia incidence rate was 233/1000 live births and the perinatal death rate was 47/1000 live births. Suspicion of foetal distress was premised on the presence of persistent tachycardia or bradycardia during intermittent auscultation. Main resuscitative measures were left lateral repositioning of patient, fast saline infusion, intranasal oxygen administration and discontinuation of oxytocin infusion, if any. Only 124 (41.2%) of all the cases had delivery achieved within 2 h of diagnosis. Mean decision-delivery interval by caesarean section was 2.93 ± 2.05 h. Socio-demographic factors (p= 0.001) and pregnancy risk category (p = 0.002) influenced incidence of birth asphyxia. Conclusion: To reduce subsisting high perinatal morbidity and mortality in sub-Saharan Africa, it is best that at the least referral hospitals should have advanced facilities for foetal monitoring and shortened surgical intervention time.