# Long-term neurological health of the term offspring born via cesarean section for non-reassuring fetal monitoring

## TL;DR

This study found that cesarean sections due to non-reassuring fetal heart rate do not increase long-term neurological risks in children.

## Contribution

The study provides new evidence that cesarean delivery for non-reassuring fetal monitoring does not lead to higher long-term neurological issues in children.

## Key findings

- Children born via cesarean for non-reassuring fetal heart rate had similar neurological outcomes as those born for non-progressive labor.
- Prompt intervention during non-reassuring fetal monitoring may prevent long-term neurological complications.
- The study controlled for multiple confounders and found no significant risk increase for neurological morbidity.

## Abstract

While some evidence suggests that intrapartum fetal heart rate (FHR) monitoring is associated with a reduction in intrapartum death, a reduction in long-term neurological impairment has not been proven. In this study, we sought to evaluate the offspring long-term neurological morbidity of children born via cesarean delivery (CD) for non-reassuring FHR (NRFHR) indication.

A population-based cohort analysis was performed comparing long-term neurological morbidity of term children born via CD for NRFHR as compared with children born via CD for non-progressive labor (NPL), at a single medical center. Neurological morbidity of the offspring was assessed using data from community-based clinics and/or hospitalizations up to 18 years involving neurological morbidity. A Kaplan–Meier survival curve was used to compare cumulative neurological morbidity incidence between the groups. A generalized estimating equations (GEE) model was used to control for possible confounders.

14,333 term singleton intrapartum CDs met the inclusion criteria. Of those, 59.0% were for NRFHR indication and 41.0% for NPL. Rate of total long-term neurological morbidity was comparable between the groups. The Kaplan–Meier survival curve also shows comparable cumulative incidence of neurological morbidity in both groups (Log-rank, p = 0.390). In the GEE model, controlling for repeated deliveries of the same mother (siblings), child birth year, follow-up time and multiple other confounders, NRFHR leading to CD was not found as a risk factor for offspring long-term neurological morbidity (aHR 1.87, 95%CI 0.74–4.72, p = 0.184).

Intrapartum NRFHR leading to CD did not predict long-term neurological morbidity of the offspring, possibly due to prompt intervention.

The online version contains supplementary material available at 10.1007/s00404-025-08258-2.