Risk factors for a serious adverse outcome in neonates: a retrospective cohort study of vaginal births
Author(s)
Type
Journal Article
Abstract
Objective
To investigate the hypothesis that risk factors in addition to an abnormal fetal heart rate pattern (aFHRp) are independently associated with adverse neonatal outcomes of labour.
Design
Observational prospective cohort study.
Setting
17 UK maternity units.
Sample
585 291 pregnancies between 1988 and 2000 inclusive.
Methods
Adjusted odds ratios (OR) with 95% confidence intervals (95% CI) were estimated from multivariable logistic regression.
Main outcome measures
Adverse neonatal outcome at term (5-minute Apgar score <7, and a composite measure comprising 5-minute Apgar score <7, resuscitation by intubation and/or perinatal death).
Results
Analysis was based on 302 137 vaginal births at 37–42 weeks inclusive. We found a higher odds of Apgar score at 5 minutes <7 with suspected fetal growth restriction (OR 1.34, 95% CI 1.16–1.53), induction of labour (OR 1.41, 95% CI 1.25–1.58), nulliparity (OR 1.48, 95% CI 1.34–1.63), booking body mass index ≥30 (OR 1.18, 95% CI 1.02–1.37), maternal age <25 (OR 1.23, 95% CI 1.10–1.39), black ethnicity (OR 1.21, 95% CI 1.03–1.43), early-term birth at 37–38 weeks (OR 1.13, 95% CI 1.02–1.25), late-term birth at 41–42 weeks (OR 1.14, 95% CI 1.01–1.28), use of oxytocin (OR 1.27, 95% CI 1.14–1.41), maternal pyrexia (OR 1.87, 95% CI 1.46–2.40), aFHRp and presence of meconium (aFHRp without meconium: OR 2.40, 95% CI 2.15–2.69; meconium without aFHRp: OR 2.20, 195% CI.94–2.49; both aFHRp and meconium: OR 4.26, 95% CI 3.74–4.87). The results were similar when the composite adverse outcome was considered.
Conclusions
A range of risk factors, including suspicion of fetal growth restriction, maternal pyrexia and presence of meconium, are implicated in poor birth outcomes in addition to aFHRp. Interpretation of the fetal heart rate pattern alone is insufficient as a basis for decisions about escalation and intervention.
To investigate the hypothesis that risk factors in addition to an abnormal fetal heart rate pattern (aFHRp) are independently associated with adverse neonatal outcomes of labour.
Design
Observational prospective cohort study.
Setting
17 UK maternity units.
Sample
585 291 pregnancies between 1988 and 2000 inclusive.
Methods
Adjusted odds ratios (OR) with 95% confidence intervals (95% CI) were estimated from multivariable logistic regression.
Main outcome measures
Adverse neonatal outcome at term (5-minute Apgar score <7, and a composite measure comprising 5-minute Apgar score <7, resuscitation by intubation and/or perinatal death).
Results
Analysis was based on 302 137 vaginal births at 37–42 weeks inclusive. We found a higher odds of Apgar score at 5 minutes <7 with suspected fetal growth restriction (OR 1.34, 95% CI 1.16–1.53), induction of labour (OR 1.41, 95% CI 1.25–1.58), nulliparity (OR 1.48, 95% CI 1.34–1.63), booking body mass index ≥30 (OR 1.18, 95% CI 1.02–1.37), maternal age <25 (OR 1.23, 95% CI 1.10–1.39), black ethnicity (OR 1.21, 95% CI 1.03–1.43), early-term birth at 37–38 weeks (OR 1.13, 95% CI 1.02–1.25), late-term birth at 41–42 weeks (OR 1.14, 95% CI 1.01–1.28), use of oxytocin (OR 1.27, 95% CI 1.14–1.41), maternal pyrexia (OR 1.87, 95% CI 1.46–2.40), aFHRp and presence of meconium (aFHRp without meconium: OR 2.40, 95% CI 2.15–2.69; meconium without aFHRp: OR 2.20, 195% CI.94–2.49; both aFHRp and meconium: OR 4.26, 95% CI 3.74–4.87). The results were similar when the composite adverse outcome was considered.
Conclusions
A range of risk factors, including suspicion of fetal growth restriction, maternal pyrexia and presence of meconium, are implicated in poor birth outcomes in addition to aFHRp. Interpretation of the fetal heart rate pattern alone is insufficient as a basis for decisions about escalation and intervention.
Date Issued
2023-11
Date Acceptance
2023-04-23
Citation
BJOG: an International Journal of Obstetrics and Gynaecology, 2023, 130 (12), pp.1521-1530
ISSN
1470-0328
Publisher
Wiley
Start Page
1521
End Page
1530
Journal / Book Title
BJOG: an International Journal of Obstetrics and Gynaecology
Volume
130
Issue
12
Copyright Statement
© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000985606400001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=a2bf6146997ec60c407a63945d4e92bb
Subjects
APGAR SCORE
fetal deterioration
FETAL HEART-RATE
INFANT
INTRAPARTUM
intrapartum fetal monitoring
labour outcome
Life Sciences & Biomedicine
meconium
Obstetrics & Gynecology
pyrexia
risk factors
Science & Technology
TRIAL
Publication Status
Published
Date Publish Online
2023-05-08