The iPREFACE score is useful for predicting fetal acidemia: A retrospective cohort study of 113 patients who underwent emergency cesarean section for non-reassuring fetal status during labor

Background: iPREFACE scores may aid in predicting fetal acidemia and neonatal asphyxia in emergency cesarean sections and vaginal deliveries, which may improve labor management precision in the future.Objective: To assess the utility of the iPREFACE score as an objective indicator to determine the need for rapid delivery in cases of repeated abnormal waveforms without concurrent indications for immediate medical intervention during labor.Study Design: This retrospective cohort study was conducted on term (37+ 0 days to 41+6 days) singleton pregnant women undergoing emergency cesarean section owing to a non-reassuring fetal status. The iPREFACE-DCS score, calculated from a 30-min cardiotocography waveform before the detecision of emergency cesarean section, and the iPREFACE-RCT score, calculated from a 30-min cardiotocography waveform before cardiotocography transducer removal, were employed. The primary outcome was the assessment of the predictive ability of these scores for fetal acidemia, whereas the secondary outcomes were differences in umbilical artery blood gas findings and postnatal outcomes between the two groups, divided by the cutoff values of the iPREFACE-RCT score.Results: The iPREFACE-DCS and iPREFACE-RCT scores demonstrated predictive capabilities for an umbilical artery blood pH of <7.2. The iPREFACE-DCS-RCT score, with a cutoff value of 37/46 points, exhibited an area under the receiver operating characteristic curve of 0.82/0.87. The iPREFACE-RCT ≥46 points group had higher incidence rates of an umbilical cord artery blood pH of <7.2, <7.1, and <7.0, and neonatal intensive care unit admissions for neonatal asphyxia.Conclusions: The iPREFACE score, derived from cardiotocography during emergency cesarean section, may enable clinicians to predict fetal acidemia in cases of non-reassuring fetal status. Improved prediction of fetal acidemia and facilitating timely intervention hold promise for enhancing the outcomes of mothers and newborns during childbirth. Prospective studies are warranted to establish precise cutoff values and validate the clinical application of these scores.