MANAGEMENT AND FETAL OUTCOMES OF SECOND STAGE FETAL COMPROMISE: A CROSS-SECTIONAL ANALYSIS AT THE GYNECOLOGY DEPARTMENT.

.JPUMHS;2024:14:04,176-184. http://doi.org/10.46536/jpumhs/2024/14.04.577

Abstract

BACKGROUND: Second-stage fetal compromise is a critical obstetric emergency that
requires prompt intervention to prevent adverse neonatal outcomes. Prolonged second-stage
labor, fetal distress, and maternal exhaustion contribute to fetal hypoxia, leading to increased
morbidity and mortality. Effective management strategies, including operative vaginal
delivery and emergency cesarean section, play a crucial role in optimizing fetal outcomes.
OBJECTIVES: This study aims to evaluate the management approaches and fetal outcomes
in cases of second-stage fetal compromise. Specific objectives include identifying risk
factors, assessing different intervention strategies, and analyzing neonatal outcomes such as
Apgar scores, NICU admissions, and perinatal mortality. METHODS: A cross-sectional
study was conducted at the Gynecology Department, analyzing 220 cases of second-stage
fetal compromise. Data were collected from medical records, including maternal
demographics, fetal heart rate monitoring, mode of delivery, and neonatal outcomes.
Statistical analysis was performed using SPSS, applying chi-square and logistic regression
tests to determine associations between management strategies and fetal outcomes.
RESULTS: Among the 220 cases, 60% underwent emergency cesarean section, 30%
required instrumental delivery forceps/vacuum, and 10% had spontaneous vaginal delivery.
Neonatal outcomes showed that Apgar scores ≤ 7 at 5 minutes were observed in 25% of
cases, while NICU admission was required in 18%. Perinatal mortality was 4%, primarily
associated with prolonged fetal distress. Emergency cesarean section was significantly
associated with improved neonatal outcomes p < 0.05. CONCLUSION: Timely
identification and appropriate management of second-stage fetal compromise significantly
improve neonatal outcomes. Emergency cesarean section remains the most effective
intervention in severe cases. Strengthening intrapartum monitoring and decision-making can
further enhance fetal survival rates.