Antepartum Risk Research Articles

Predicting Cesarean Delivery After Induction of Labor Among Nulliparous Women at Term.

To identify independent risk factors for cesarean delivery after induction of labor and to develop a nomogram for predicting cesarean delivery among nulliparous women undergoing induction of labor at term. This is a retrospective cohort study including nulliparous women with singleton, term (37 0/7 weeks of gestation or greater), cephalic pregnancies undergoing induction of labor from July 1, 2006, through May 31, 2012, at a tertiary care academic center. Inductions were identified using International Classification of Diseases, 9th Revision codes. Demographic, delivery, and outcome data were abstracted manually from the medical record. Women with a contraindication to vaginal delivery (malpresentation, abnormal placentation, prior myomectomy) were excluded. Independent risk factors for cesarean delivery were identified using logistic regression. During the study period, there were 785 nulliparous inductions that met study criteria; 231 (29.4%) underwent cesarean delivery. Independent risk factors associated with an increased risk of cesarean delivery included older maternal age, shorter maternal height, greater body mass index, greater weight gain during pregnancy, older gestational age, hypertension, diabetes mellitus, and initial cervical dilation less than 3 cm. A nomogram was constructed based on the final model with a bias-corrected c-index of 0.709 (95% confidence interval 0.671-0.750). We identified independent risk factors that can be used to predict cesarean delivery among nulliparous women undergoing induction of labor at term. If validated in other populations, the nomogram could be useful for individualized counseling of women with a combination of identifiable antepartum risk factors. II.

A simple model for prediction postpartum PTSD in high-risk pregnancies

This study aimed to examine the prevalence and possible antepartum risk factors of complete and partial post-traumatic stress disorder (PTSD) among women with complicated pregnancies and to define a predictive model for postpartum PTSD in this population. Women attending the high-risk pregnancy outpatient clinics at Sheba Medical Center completed the Edinburgh Postnatal Depression Scale (EPDS) and a questionnaire regarding demographic variables, history of psychological and psychiatric treatment, previous trauma, previous childbirth, current pregnancy medical and emotional complications, fears from childbirth, and expected pain. One month after delivery, women were requested to repeat the EPDS and complete the Post-traumatic Stress Diagnostic Scale (PDS) via telephone interview. The prevalence rates of postpartum PTSD (9.9%) and partial PTSD (11.9%) were relatively high. PTSD and partial PTSD were associated with sadness or anxiety during past pregnancy or childbirth, previous very difficult birth experiences, preference for cesarean section in future childbirth, emotional crises during pregnancy, increased fear of childbirth, higher expected intensity of pain, and depression during pregnancy. We created a prediction model for postpartum PTSD which shows a linear growth in the probability for developing postpartum PTSD when summing these seven antenatal risk factors. Postpartum PTSD is extremely prevalent after complicated pregnancies. A simple questionnaire may aid in identifying at-risk women before childbirth. This presents a potential for preventing or minimizing postpartum PTSD in this population.

Factores de riesgo del parto pretérmino: Estudio caso-control

OBJETIVOS: Determinar los factores de riesgo maternos y fetales que se asocian al parto prematuro. Material y MÉTODOS: Estudio retrospectivo, comparativo, caso control, basado en las historias clínicas y entrevistas de las pacientes cuyos partos fueron atendidos en el Hospital Nacional Cayetano Heredia, entre el 1 de enero y el 31 de marzo de 2003. Se incluyó todos los casos (106 prematuros) y controles (1325 a término) que ocurrieron en el periodo de estudio. En la evaluación estadística se usó el análisis multivariado (regresión logística); con ello se determinó el odds ratio (razón de productos) y el intervalo de confianza de cada variable. El nivel de significancia utilizado fue del 95% (p<0,05]. RESULTADOS: Los factores de riesgo maternos fueron edad<20 años, antecedente de prematuridad, control prenatal inadecuado, infección urinaria, rotura prematura de membranas, preeclampsia-eclampsia y hemorragia anteparto y los factores de riesgo fetales, muerte intrauterina, embarazo gemelar y mala presentación.

Effect of depressive and anxiety symptoms during pregnancy on risk of obstetric interventions.

The effect of prenatal mental health on the risk of obstetric interventions is unclear. The present study examined the associations between depressive and anxiety symptoms in the second and third trimesters and mode of delivery, epidural use and labor induction in a large community-based pregnancy cohort, in Alberta, Canada. Women who had singleton pregnancies, delivered in hospital, and had medical data were selected (n = 2825). Obstetric intervention data were obtained from the medical records, and depressive and anxiety symptoms were measured by the Edinburgh Postnatal Depression Scale and the Spielberger State Anxiety Inventory. Data were evaluated with multivariate multinomial and logistic regression analyses using a hierarchical modeling. After accounting for factors known to increase the risk of each intervention, including demographic variables, smoking, hospital site, gestational age, previous history of cesarean delivery, prepregnancy body mass index, assisted conception, and antepartum risk score, the only mental health variable associated with obstetric interventions was depressive symptoms in the third trimester, which increased the risk of emergency cesarean delivery (adjusted odds ratio, 2.04; 95% confidence interval, 1.26-3.29). No associations were found between antenatal depressive and anxiety symptoms and other obstetric interventions. The present findings support an association between depressive symptoms and adverse obstetric outcomes and suggest that anxiety and depression may have different effects on obstetric outcomes. Understanding the mechanism in which depression increases the risk of emergency cesarean birth needs further research.

40: Duration of mechanical ventilation is an independent risk factor for cerebral palsy

Several antepartum and intrapartum risk factors are associated with cerebral palsy (CP); however, need and duration of neonatal mechanical ventilation (MV) may contribute to CP. One function of MV is to protect the brain from hypoxemia and asphyxia; however, MV use has been associated with adverse effects on the brain of a preterm infant. Currently, there is limited information regarding the duration of MV and incidence of CP; our objective, was to investigate this association.

"Risk factors of birth asphyxia".

BackgroundBirth asphyxia is an insult to the fetus or newborn due to failure to breath or breathing poorly, leads to decrease oxygen perfusion to various organs. According to WHO, 4 million neonatal deaths occurred each year due to birth asphyxia. Our goal was to evaluate antepartum, intrapartum, and fetal risk factors of birth asphyxia.MethodsIt was a Retrospective Case control study, conducted at Neonatal Intensive Care Unit of pediatric ward (I, II, III) and in Gynecology wards (I, II, III) of Civil Hospital Karachi, Dow University of Health Sciences. Study was conducted from January 2011-November 2012. Neonates diagnosed with birth asphyxia were considered as “cases” while neonates born either with normal vaginal delivery or by cesarean section having no abnormality were considered as “control”. Demographics of both the mother and neonate were noted and Questions regarding possible risk factors were asked from mother. Ethical issues were confirmed from Institutional review board of Civil Hospital Karachi, Dow University of Health Sciences. All data was entered and analyzed through SPSS 19.ResultOut of total 240 neonates, 123 were “cases” and 117 were “control”. Mean maternal age in “case” group was 24.22 ± 3.38 while maternal age of control group was 24.30 ± 4.04. Significant antepartum risk factors were maternal age of 20–25 (OR 0.30 CI 95% 0.07-1.21), booking status (OR 0.20 CI 95% 0.11-0.37), pre-eclampsia (OR 0.94 CI 95% 0.90-0.98) and primigravidity (OR 2.64 CI 95% 1.56-4.46). Significant Intrapartum risk factors were breech presentation (OR 2.96 CI 95% 1.25-7.02), home delivery (OR 16.16 CI 95% 3.74-69.75) and maternal fever (OR 10.01 CI95% 3.78-26.52). Significant Fetal risk factors were resuscitation of child (OR 23 CI 95% 31.27-1720.74), pre-term babies(OR 0.34 CI 95% 0.19-0.58), fetal distress (OR 0.01 CI 95% 0.00-0.11) and baby weight (OR 0.13 CI 95% 0.05-0.32).ConclusionMeasures should be taken to prevent neonatal mortality with great emphasis on skilled attendance at birth and appropriate care of preterm and low birth weight neonates.

Risk score comprising maternal and obstetric factors to identify late preterm infants at risk for neonatal intensive care unit admission.

The aim of this study was to develop and validate an antepartum risk score based on maternal and obstetric characteristics to predict the requirement for neonatal intensive care unit (NICU) admission among late preterm infants. A chart review was performed of 455 singleton late preterm deliveries at our institution between July 2010 and December 2011. Logistic regression analysis was used to develop a risk score, which was derived from β coefficients of the significant variables. A receiver-operator curve was plotted to determine the optimal cut-off score for predicting NICU admission. Validation of the score was tested in another cohort of 450 women who delivered a singleton late preterm infant between January 2012 and June 2013. A total of 98 infants (21.5%) in the development cohort were admitted to the NICU. The significant factors for NICU admission included: premature rupture of membranes, antepartum hemorrhage, medical disorders during pregnancy, prenatal estimation of fetal weight, gestational age at delivery, and mode of delivery. These six variables were integrated into a risk-scoring model, which ranged from -2 to 9 points. A cut-off score of ≥1 produced the maximum area under the receiver-operator curve of 0.764. At this cut-off point, the sensitivity was 79.6% and specificity was 73.1%. When the risk score was tested in the validation cohort, similar results were demonstrated. An antepartum risk score was developed to predict the requirement for NICU admission among late preterm infants and was validated in an independent cohort.

The transition of late preterm

Background The transition from the intrato the extra-uterine life is characterized by major physiological changes in respiratory and hemodynamic functions [1]; moreover, the intrauterine thermostability has to been replaced by the neonatal termoregulation [2]. Many of the antepartum and intrapartum risk factors associated with the need of resuscitation may be present in late-preterm neonates (34-36 weeks) [3]. It is also reported a double risk of Caesarean Section (CS) in case of late-preterm compared to term deliveries [4]. Our objective was to evaluate the transition period in late-preterm infants in particular considering the need for resuscitation and the incidence of hypothermia.

Term perinatal mortality audit in the Netherlands 2010–2012: a population-based cohort study

ObjectiveTo assess the implementation and first results of a term perinatal internal audit by a standardised method.DesignPopulation-based cohort study.SettingAll 90 Dutch hospitals with obstetric/paediatric departments linked to community practices of...

Amniotic fluid embolism: antepartum, intrapartum and demographic factors

Objective: To describe the incidence, antepartum, intrapartum and postpartum risk factors, and mortality rate of amniotic fluid embolism (AFE).Methods: We used 2001–2007 California health discharge data to identify cases of AFE by ICD-9 codes.Results: Of 3 556 567 deliveries during the time period, we identified 182 cases of AFE, resulting in a population incidence of 5.1 in 100 000. Twenty-four of the cases resulted in death, giving a case fatality rate of 13.2%. Non-Hispanic blacks had a higher than 2-fold odds of developing AFE. AFE increased significantly with maternal age, most significantly after age 39. Cardiac disease had a nearly 70-fold higher association with AFE, cerebrovascular disorders had a 25-fold higher association, while conditions such as eclampsia, renal disease, placenta previa and polyhydramnios had nearly 7- to 13-fold higher associations. Classical cesarean delivery, abruption placentae, dilation and curettage, and amnioinfusion were all procedures highly associated with AFE.Conclusion: Several antepartum and peripartum conditions and procedures are associated with significantly higher risks of amniotic fluid embolism. This information may contribute to a better understanding of the pathophysiology of AFE and potentially help identify those at the highest risk of developing this morbid condition.

Incidence and prediction of outcome in hypoxic–ischemic encephalopathy in Japan

BackgroundHypoxic–ischemic encephalopathy (HIE) is one of the most critical pathologic conditions in neonatal medicine due to the potential for neurological deficits in later life. We investigated the incidence of term infants with moderate or severe HIE in Japan and identified prognostic risk factors for poor outcome in HIE.MethodsData on 227 infants diagnosed with moderate or severe HIE and born between January and December 2008 were collected via nationwide surveys from 263 responding hospitals. Using logistic regression, we examined the relationship between maternal, antepartum, intrapartum, and neonatal risk factors and clinical outcome at 18 months following birth.ResultsIn Japan, the incidence of moderate or severe HIE was 0.37 per 1000 term live births. Outborn births, low Apgar score at 5 min, use of epinephrine, and low cord blood pH were intrapartum factors significantly associated with neurodevelopmental delay and death at 18 months. Serum lactate, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase (all, P < 0.001) and creatine kinase (P = 0.002) were significantly higher in infants with poor outcome compared to those with favorable outcomes. Abnormal brain magnetic resonance imaging (MRI), an important prognostic factor, was significantly associated with poor outcome (odds ratio, 11.57; 95% confidence interval: 5.66–23.64; P < 0.001).ConclusionsRisk factors predicting poor outcome in HIE include outborn birth, low Apgar score at 5 min, use of epinephrine, laboratory abnormalities, and abnormal MRI findings.

English

OBJECTIVE: To find out the incidence, neonatal outcome and associated maternal antepartum & intrapartum risk factors of meconium stained amniotic fluid (MSAF). DESIGN: Prospective Study. SETTINGS: Neonatal Unit of Hospital and PNC Ward. SUBJECTS & METHODS: Prospective Study was conducted including 100 babies born with meconium stained amniotic fluid who are admitted in NICU and with mother in PNC ward in a period of six months (April 2012October 2012) excluding those who born with congenital abnormalities. Detail history of babies and mother with MSAF noted with emphasis on antepartum and intrapartum risk factors and outcome in terms of morbidity and mortality. RESULTS: Incidence of MSAF in the study was 8. 98%. Out of 100, 24 babies were admitted to NICU with most common indications being birth asphyxia (16%) and Meconium Aspiration Syndrome (MAS) (6%). Majority babies were delivered through thin Meconium Stained Liquor (MSL) (44%) followed by thick (35%) and moderate (21%). Total number of deaths were 9 and all these babies had thick meconium with severe birth asphyxia. Ninety one babies were born at >37 weeks of gestation and 57 had birth weight over 2. 5 Kg. Nineteen percent were non vigorous requiring tracheal suctioning and positive pressure ventilation at birth. Common mode of delivery was emergency Cesarean in 83% patients. Common maternal and fetal risk factors were fetal distress (30%) followed by Oligohydramnios (30%), Pregnancy induced hypertension (PIH) (24%), anemia (14%), severe anemia (5%), Antepartum hemorrhage (4%) and Antepartum eclampsia (4%). CONCLUSIONS: Oligohydramnios, PIH, anemia and fetal distress were common antenatal and intranatal factors associated with MSAF. Major morbidity and indication for NICU admission was Birth asphyxia and non vigorous babies. Mortality rate was 9% which is commonly associated with thick meconium and severe birth asphyxia.

A risk stratification model to predict adverse neonatal outcome in labor

The development and evaluation of a labor risk model consisting of a combination of antepartum risk factors and intrapartum fetal heart rate (FHR) characteristics that can reliably identify those infants at risk for adverse neonatal outcome in labor. A nested case-control study of term singleton deliveries at the nine hospitals between March 2007 and December 2009. Eligibility criteria included: gestational age ≥ 37.0 weeks; singleton pregnancy; documented continuous FHR monitoring for ≥ 2 h before delivery; assessment of FHR tracing at least every 20 min; and, available maternal and neonatal outcomes. Adverse neonatal outcome was defined as nonanomalous infants admitted to the newborn intensive care unit with either a 5 minute Apgar score <7 or an umbilical artery pH<7.1. Initial risk score was determined using data available at 1 h after admission. Patients with an initial risk score between 7 and 15 were considered high risk. Intrapartum risk scores were then created for these patients using FHR tracing data and labor characteristics. A total of 51 244 patients were identified meeting study criteria. Of the antepartum variables evaluated (n=31), 10 were associated with an adverse outcome. The high-risk group made up 28% of the population and accounted for 59.8% of the adverse outcomes. Intrapartum characteristics were then evaluated in this high-risk group. Intrapartum evaluation identified the highest risk group with a C/S rate of 40% and adverse outcome rate of 11.3%. Incorporation of maternal and antepartum risk factors with FHR analysis can improve the ability to identify the fetus at risk in labor.

Outcome of pregnancies with preterm prelabor rupture of membranes before 27 weeks’ gestation: a retrospective cohort study

ObjectivePreterm prelabor rupture of membranes (PPROM) before 27 weeks’ gestation is associated with severe perinatal complications, but quantitative estimates are lacking. The aim of this study was to report and predict outcomes of pregnancies complicated by early PPROM and to study antepartum risk factors that might predict perinatal death in future patients. Study designWe performed a retrospective cohort study of women with PPROM between 13+0 weeks and 27+0 weeks’ gestation between 1994 and 2009 in three perinatal centers. Main outcome measuresPerinatal mortality, composite neonatal morbidity and premature delivery. A model to predict these outcomes was developed from antepartum variables. ResultsWe identified 314 women with PPROM before 27 weeks, including 28 multiple pregnancies. Six pregnancies (2%) were terminated before 24 weeks’ gestation, and three were lost to follow up, leaving 305 pregnancies for analysis. Overall, there were 166 perinatal deaths (49%). The perinatal mortality rate decreased with increasing gestational age at PPROM (from 70% in the group PPROM 13–20 weeks to 27% in the group PPROM 24–27 weeks). Of the 170 surviving neonates, 70 suffered from serious morbidity (41%). Early gestational age at PPROM, long interval between PPROM and birth and positive vaginal culture (any bacteria) were associated with perinatal mortality. ConclusionPerinatal mortality in PPROM before 27 weeks occurred in half of the cases and among those who survive approximately 40% suffered serious morbidity. Antenatal parameters can be helpful to predict perinatal mortality.

Intrapartum Asphyxia, Neonatal Encephalopathy, Cerebral Palsy, and Obstetric Interventions in the Term and Near-Term Infant

Intrapartum asphyxia (IA) as a cause of neonatal encephalopathy (NE) and cerebral palsy (CP) is a concern for obstetric providers due to the significant neonatal sequelae that ensue. CP is a nonprogressive static neuromuscular disorder appearing early after birth that occurs in 2 per 1,000 births. NE is a clinical syndrome of disturbed neurologic function in the first week after birth, and it occurs in 6 per 1,000 live births. Only ∼6% of all term infants diagnosed with CP have a history of NE, and without the development of NE, IA cannot be considered as the sole cause of CP. There are various preconceptional, antepartum, and intrapartum risk factors associated with CP. Obstetric interventions, including various modalities of fetal monitoring and cesarean delivery, have not led to improvement in outcomes or a reduction in the incidence of CP. The goal of this review was to discuss the association of IA with NE and CP in term and near-term infants, with a focus on the diagnosis and risk factors for IA and potential obstetric interventions.

Risk factors for birth asphyxia in an urban health facility in cameroon.

The World Health Organization (WHO) estimates that 4 million children are born with asphyxia every year, of which 1 million die and an equal number survive with severe neurologic sequelae. The purpose of this study was to identify the risk factors of birth asphyxia and the hospital outcome of affected neonates. This study was a prospective case-control study on term neonates in a tertiary hospital in Yaounde, with an Apgar score of < 7 at the 5th minute as the case group, that were matched with neonates with an Apgar score of ≥ 7 at the 5th minute as control group. Statistical analysis of relevant variables of the mother and neonates was carried out to determine the significant risk factors. The prevalence of neonatal asphyxia was 80.5 per 1000 live births. Statistically significant risk factors were the single matrimonial status, place of antenatal visits, malaria, pre-eclampsia/eclampsia, prolonged labor, arrest of labour, prolonged rupture of membranes, and non-cephalic presentation. Hospital mortality was 6.7%, that 12.2% of them had neurologic deficits and/or abnormal transfontanellar ultrasound/electroencephalogram on discharge, and 81.1% had a satisfactory outcome. The incidence of birth asphyxia in this study was 80.5% per1000 live birth with a mortality of 6.7%. Antepartum risk factors were: place of antenatal visit, malaria during pregnancy, and preeclampsia/eclampsia. Whereas prolonged labor, stationary labor, and term prolonged rupture of membranes were intrapartum risk faktors. Preventive measures during prenatal visits through informing and communicating with pregnant women should be reinforced.

The Role of Fetal Neurology in the Progress of Perinatal Medicine

The prevalence of cerebral palsy has not decreased despite major improvements in clinical care in antenatal/ neonatal period as well as intrapartum period. In about 70% of cases, cerebral palsy results from events occurring before birth that can disrupt normal development of the brain. The antepartum risk factors should include fetal brain mal development and intrauterine brain injuries, which are unclassifiable into congenital brain anomalies and may exist inconspicuously during pregnancy and even after birth. Especially, neuronal migration disorder and acquired brain damage in utero should be responsible for postnatal neurological impairment. Imaging technologies including three dimensional ultrasound have been remarkably improved and contributed to prenatal evaluation of fetal Central Nervous System (CNS) development and assessment of CNS abnormalities in utero. In this article, objective and precise imaging diagnoses of fetal CNS including migration disorders and acquired brain damages. Furthermore, 3D bidirectional power Doppler angiography has depicted fine cerebral vessels of medullary veins which may relate with timing of insult as well as with postnatal neurological prognosis. It is promising to clarify the developmental mechanism of CNS damages with advanced ultrasound diagnostic techniques in the near future. Postnatal unexplained neurological deficits may strongly relate with intrauterine brain development therefore fetal neurology has great responsibility and an important role in perinatal medicine.

785: Antepartum risk factors and delivery-related morbidities in cases of failed operative vaginal deliveries

784 Failure rate and delivery-related maternal morbidity in vacuum delivery, forceps delivery, or a combination of both Alex Fong, Erica Wu, Deyu Pan, Dotun Ogunyemi, Judith Chung University of California, Irvine, Obstetrics and Gynecology, Orange, CA, Charles Drew University of Medicine and Science, Research SLI, Los Angeles, CA, University of California, Los Angeles, Obstetrics and Gynecology, Los Angeles, CA OBJECTIVE: To assess the differences in delivery-related morbidity and failure rate when comparing vacuum delivery, forceps delivery, or combined use of both. STUDY DESIGN: We used 2001-2007 California discharge data to identify cases of forceps and vacuum delivery via ICD-9. After eliminating cases with incomplete data, we identified 202,439 cases of vacuum, 13,555 cases of forceps, and 710 cases where both were used. We used logistic regression to adjust for potential confounders. RESULTS: Morbidities increased in forceps compared to vacuum deliveries included third/fourth degree lacerations (OR 2.07, 95%CI 1.98-2.16), postpartum hemorrhage (OR 1.51, 95%CI 1.39-1.64), manual extraction of placenta (OR 1.35, 95%CI 1.17-1.55), pelvic hematoma requiring evacuation (OR 2.05, 95%CI 1.44-2.91), and cervical laceration repair (OR 1.73, 95%CI 1.27-2.36). There was a trend towards increased risk of thromboembolic events in forceps deliveries (OR 2.93, 95%CI 1.00-8.62). When a combination of both instruments was used, third/fourth degree lacerations were increased compared to both vacuum (OR 2.77, 95% CI 2.36-3.26) and forceps (OR 1.39, 95% CI 1.80-1.64). Postpartum hemorrhage was increased compared to vacuum as well (OR 1.81, 95% CI 1.33-2.47). Compared to forceps deliveries, vacuum deliveries were more associated with shoulder dystocia (OR 1.43, 95% CI 1.28-1.60). Forceps had the lowest failure rate (2.14%), followed by increased failure rates in combined use (3.66%, OR 1.85, 95% CI 1.22-2.79) and vacuum (5.60%, OR 2.65, 95% CI 2.37-2.97). CONCLUSION: Forceps delivery is the most successful in achieving vaginal delivery but appears to be associated with several delivery-related morbidities. Combining both vacuum and forceps is more successful than vacuum alone, but is no better than forceps alone, and is associated with even further morbidity. These results, in conjunction with each method’s neonatal risks, should be considered prior to contemplating use of vacuum, forceps, or both at delivery.

Risk factors for failed induction in nulliparous women

Objective: To identify risk factors for failed induction in nulliparous women. Material and methods: A retrospective cohort study of nulliparous women admitted for induction of labour (IOL). Identification of risk factors for failed IOL by comparing clinical characteristics of patients with a failed IOL defined as birth by caesarean section (LSCS) with those achieving vaginal birth. Results: During a 12 month episode, 400 nulliparous women had an IOL; of these 168 (42%) failed to deliver vaginally. Independent antenatal risk factors for failed IOL were higher maternal age (OR = 1.052 per additional year), being shorter (OR = 1.112 per cm less maternal height) and a lower cervical dilatation score (OR = 1.411 per lower cervical dilatation score). A longer active phase (OR = 1.004 per additional minute) was the only independent intrapartum risk factor for having a LSCS. Conclusions: Maternal age, height and cervical dilatation are independent antepartum risk factors, while duration of active phase is the single independent intrapartum risk factor for a failed IOL. Increased maternal BMI was less of a risk factor than anticipated with increased risk for failed IOL, as independent risk factor, more or less restricted to the morbidly obese women.

Neonatal asphyxia: A study of 210 cases

Objectives: Perinatal asphyxia remains an important cause of neonatal morbidity and mortality. The aim of this study was to investigate antenatal, natal, and postnatal risk factors of neonatal asphyxia, relationship with known risk factors and stage of Sarnat and Sarnat scores, the effect of risk factors on hospital discharge and survival for neonates with perinatal asphyxia. Materials and methods: In this study, we retrospectively analyzed the hospital records of 210 patients diagnosed as perinatal asphyxia. The patients' demographic characteristics, antepartum, intrapartum, and postpartum risk factors and Sarnat and Sarnat clinical staging criteria of newborns were analyzed. Results: The risk factors for asphyxia were detected antepartum period in 67.7% of newborns, intrapartum in 91% and potpartum in of 29.5% of neonates. When cases were examined according to the studied years, perinatal asphyxia ratio was the most frequent in 2007 as 28.1%. With a decline over the years, frequency dropped to %21 in 2010. The number of patients with stage 3 and mortality rate were significantly decreased over the years (p