Long-term neurological health of the term offspring born via cesarean section for non-reassuring fetal monitoring

PURPOSE: While some evidence suggests that intrapartum fetal heart rate (FHR) monitoring is associated with a reduction in intrapartum death, a reduction in long-term neurological impairment has not been proven. In this study, we sought to evaluate the offspring long-term neurological morbidity of children born via cesarean delivery (CD) for non-reassuring FHR (NRFHR) indication. METHODS: A population-based cohort analysis was performed comparing long-term neurological morbidity of term children born via CD for NRFHR as compared with children born via CD for non-progressive labor (NPL), at a single medical center. Neurological morbidity of the offspring was assessed using data from community-based clinics and/or hospitalizations up to 18 years involving neurological morbidity. A Kaplan-Meier survival curve was used to compare cumulative neurological morbidity incidence between the groups. A generalized estimating equations (GEE) model was used to control for possible confounders. RESULTS: 14,333 term singleton intrapartum CDs met the inclusion criteria. Of those, 59.0% were for NRFHR indication and 41.0% for NPL. Rate of total long-term neurological morbidity was comparable between the groups. The Kaplan-Meier survival curve also shows comparable cumulative incidence of neurological morbidity in both groups (Log-rank, p = 0.390). In the GEE model, controlling for repeated deliveries of the same mother (siblings), child birth year, follow-up time and multiple other confounders, NRFHR leading to CD was not found as a risk factor for offspring long-term neurological morbidity (aHR 1.87, 95%CI 0.74-4.72, p = 0.184). CONCLUSIONS: Intrapartum NRFHR leading to CD did not predict long-term neurological morbidity of the offspring, possibly due to prompt intervention.