Chances of Adverse Neonatal Outcome in High-Risk and Low-Risk Obstetrical Patients

Abstract

Objective To analyze and compare occurrence of adverse immediate neonatal outcomes in high and low-risk obstetrical population. Methods Retrospective cohort study of 2370 pregnant women. The odds of adverse outcomes (i.e. low Apgar score (1–4 points) and intermediate Apgar score (5–8 points) at 1 and 5 minutes of life, birth to a small-for-gestational-age neonate (below 90th percentile of birth weight), and requirement for advanced level II-III nursery care) as well as odds of primary cesarean delivery–-were analyzed using logistic regression analysis. Results All of the studied outcomes were seen more often among the high-risk patients. When the outcomes were analyzed within a given group some interesting observations were made. The highest odds of abnormal Apgar scores (when compared to the low risk population) were seen in patients with preeclampsia–-6.06 (95% CI 3.28; 11.22) and twin pregnancies–-odds ratio of 6.63 (95% CI 2.24; 19.67). Among Small-for-Gestational-Age newborns the most frequently identified maternal condition was preeclampsia (21.57%), out of all fetal conditions twin gestation (26.67%) was number one identified scenario. The highest proportion of patients requiring advanced level nursery care (level II and III) was observed in those with twin gestation, pregnancies complicated by hypertension with and without diabetes. The highest odds of having primary cesarean delivery in laboring patients (when compared to the low risk population) were seen in the patients with IUGR fetus–-odds ratio of 26.78 [95% CI 7.65; 93.75], followed by macrosomia–-odds ratio 5.74 [95% CI 2.14; 15.41], preeclampsia–-odds ratio 5.52 [95% CI 3.14; 9.69]. For additional findings and more information on select conditions, please, refer to the full-text article. Conclusion The studied outcomes are useful markers of fetal/neonatal status and can be used to compare perinatal outcomes between different medical conditions, different locales and to assess the dynamics of fetal/neonatal well-being over the course of time. Level of Evidence II Detailed information on the studied adverse neonatal outcomes can be found in the full-text version of this document.