Assessing predictors and outcomes of suspected fetal compromise during labor in a Nigerian tertiary hospital: a retrospective cohort analysis

Intrapartum fetal monitoring is vital for assessing fetal well-being and preventing adverse outcomes during labor. While continuous electronic fetal monitoring is common in high-income countries, challenges remain, especially in low- and middle-income countries (LMICs) like Nigeria, where resource constraints affect the quality of fetal monitoring. The study aimed to identify factors associated with the diagnosis of “suspected fetal compromise” during labor. This retrospective cohort study analyzed data from 507 pregnant women at term admitted, with the aim of achieving vaginal delivery, into the labour ward of Lagos State University Teaching Hospital between May 2019 and April 2022. Data were collected using a structured proforma and analyzed with SPSS version 25. Descriptive statistics were used to summarize participant characteristics. Chi-square tests and t-tests were applied to assess associations between maternal and fetal variables and the diagnosis of suspected fetal compromise. Multivariate logistic regression was conducted to identify independent predictors of suspected fetal compromise, adjusting for potential confounders at p-value of < 0.05. The prevalence of suspected fetal compromise was 23.1%. Women who received two or more doses of intermittent preventive therapy (IPT) for malaria were 92.2% less likely to experience suspected fetal compromise (aOR = 0.08, 95%CI = 0.015–0.412, p = 0.003). Higher booking weight was also associated with a reduced risk (aOR = 0.17, 95%CI = 0.330–0.910, p = 0.038). Women diagnosed with suspected fetal compromise were significantly more likely to undergo emergency Cesarean sections (aOR = 86.1, 95%CI = 36.201-205.502, p < 0.001). There were no significant differences in one-minute APGAR scores (p > 0.6) or NICU admissions (p = 0.08) between those with and without suspected fetal compromise, suggesting effective intervention and management. This study revealed the high prevalence of intrapartum fetal compromise, emphasizing the importance of adequate fetal monitoring and the role of maternal health and malaria prevention in reducing fetal compromise. The high rate of emergency Cesarean sections for suspected fetal compromise reinforces the need for more accurate assessments to avoid unnecessary surgeries. Improving diagnostic practices, especially in LMICs, is essential for better maternal and fetal outcomes.