Cardiotocography patterns are stronger predictors of neonatal acidemia than decision-to-delivery interval in emergency cesarean deliveries

OBJECTIVES: The aim of the study was to evaluate whether non-reassuring cardiotocography (CTG) patterns or the decision-to-delivery interval is a stronger predictor of neonatal outcomes, including umbilical arterial pH and Apgar scores, in infants delivered via emergency cesarean section for suspected fetal distress. MATERIAL AND METHODS: In this retrospective cohort study, the medical records of patients who underwent emergency cesarean delivery for suspected fetal distress were reviewed. Patients were categorized according to the type of non-reassuring CTG pattern, and the association of the decision-to-delivery interval with neonatal outcomes, including umbilical arterial pH and Apgar scores, was evaluated across groups. RESULTS: A total of 131 patients were included in the study. The mean decision-to-delivery interval was 23.4 ± 7.6 minutes. Neonatal outcomes varied significantly across CTG categories, with the prolonged deceleration group showing the lowest umbilical arterial pH values and Apgar scores (p < 0.05). In contrast, the decision-to-delivery interval demonstrated only a weak association with neonatal outcomes, and regression models explained a limited proportion of the variance. Effect size analysis further indicated that CTG classification had a stronger influence on pH, Apgar 1, and Apgar 5 scores than the decision-to-delivery interval. CONCLUSIONS: Cardiotocography category was a stronger predictor of neonatal acid-base status and Apgar scores than the decision-to-delivery interval in emergency cesarean deliveries for suspected fetal distress. While minimizing time to delivery remains important, greater prognostic value lies in the type of CTG abnormality observed.