Preterm infants at high risk for EOS are those born preterm because of maternal cervical incompetence, preterm labor, premature rupture of membranes, clinical concerns for intra-amniotic infection, or acute onset of "unexplained nonreassuring fetal status
The documented cases of preterm birth associated with this condition followed spontaneous preterm labor or was the result of emergent cesarean for nonreassuring fetal status
. The formulation of a broad differential including conditions outside of obstetrics or gynecology is critical for providers when presented with an acute abdomen in pregnancy.
A live male infant weighing 1,391 g was delivered at 38 weeks of gestation by emergency cesarean section, because the cardiotocogram after the rupture of the membrane showed a nonreassuring fetal status
with severe prolonged deceleration and mild late deceleration with decreasing variability.
ICP generally has a benign prognosis in pregnant women; nevertheless, it is associated with potential adverse perinatal outcomes, including spontaneous preterm delivery, meconium-stained amniotic fluid, nonreassuring fetal status
, sudden fetal death, low APGAR scores, and neonatal respiratory distress syndrome independent of prematurity.5,8-10
Fetal indications include nonreassuring fetal status
or a need to correct for minor degrees of malposition (asynclitism, deflexion) that historically have been addressed with the use of obstetric forceps.
Cesarean delivery was indicated if at least one of the following was present: nonreassuring fetal status
(persistent category II or III); active phase arrest of dilation; arrest of descent in the second stage of labor; or failed induction of labor.
The indications for labor induction included: Over 41 weeks of gestation, maternal complications (gestational hypertension or gestational diabetes mellitus), nonreassuring fetal status
(oligohydramnios or poor placental function), and informed choices.
When comparing the indication for cesarean section (Table 4), early artificial amniotomy was associated with fewer cesarean sections performed for active phase labor dystocia (defined as arrest of active phase or arrest of descent) and more cesarean sections for nonreassuring fetal status
or latent phase labor dystocia (defined as failed induction or failure to progress), but none of these differences were statistically significant.