Fetal Distress as a Leading Indication for Primart Cesarean Section: A Cross-Sectional Study at Omdurman Maternity Hospital

ABSTRACT Fetal distress remains a leading indication for primary cesarean section (CS), yet its predictive factors in high-parity populations like those in Saudi Arabia require further elucidation. This study analyzed 1,196 primary CS cases at OMH to identify clinical and demographic predictors of fetal distress. A retrospective cross-sectional analysis was conducted using univariate and multivariate techniques. Key variables assessed included maternal age, parity, gestational age, type of CS, neonatal intensive care unit (NICU) admission, and educational level. Logistic regression models were applied to determine independent predictors. Fetal distress accounted for 17.0% (n=203) of primary CSs. Emergency CS, NICU admission, and primigravida status were significantly associated with fetal distress. Emergency CS increased the odds of fetal distress nearly threefold (AOR = 2.74; p < 0.001), while NICU admission (AOR = 2.39; p < 0.001) and primigravida status (AOR = 1.41; p = 0.043) were also independent predictors. Maternal age >25 years, gestational age <37 weeks, and lower educational level were not statistically significant in the multivariate model. The model demonstrated moderate fit (Nagelkerke R² = 0.19; Hosmer–Lemeshow p = 0.61). Emergency surgical delivery, neonatal compromise, and primigravida status were the primary drivers of fetal distress–related cesarean sections. These findings underscore the need for improved intrapartum monitoring and timely intervention protocols, especially among first-time mothers and during emergency obstetric care.