Rates Of Birth Asphyxia Research Articles

Influence of Maternal, Obstetric and Fetal Risk Factors on the Prevalence of Birth Asphyxia at Term in a Swedish Urban Population

Birth asphyxia is a perinatal occurrence that, in serious cases, may lead to permanent adverse consequences or death. This retrospective case-control study of term neonates with birth asphyxia, defined as a 5-minute Apgarscore less than 7, had as its goal to explore risk factors for birth asphyxia itself, related hypoxic-ischemic encephalopathy (HIE), and asphyxia-related disability and death. Infants who died of nonasphyxial causes, such as infection or maternal sedation, were not included. Among more than 42,000 live births reviewed for the years 1985 through 1991 in an urban Swedish population were 225 cases of birth asphyxia that were matched with nonasphyxial control cases. The study group included 75 infants with both asphyxia and HIE. Surviving infants were followed for 18 months or longer, and those viewed as neurologically disabled were followed for 1.5 to 3 years longer. Twenty-two infants in the asphyxia group died or developed asphyxia-related neurological disability. Rates of birth asphyxia, pure birth asphyxia, and asphyxia-related HIE during the 7-year review period were, respectively, 6.9, 5.4, and 1.9 per 1000 live births. The asphyxia-related mortality rate was 0.26 per 1000 live births, and the rate of neurological impairment at the 18-month follow-up was 0.2 per 1000. Factors associated with birth asphyxia included single marital status (odds ratio [OR] = 7.1), intrauterine meconium release (OR = 4.1), operative delivery (OR = 8.7), breech delivery (OR = 20.3), and oxytocin augmentation (OR = 2.9). Other associated parameters were cord complications (OR = 15.8) and external compression to aid delivery (OR = 6.2). Significant cardiotocographic (CTG) correlates included repeated late decelerations (OR = 29.4), occasional late or variable decelerations (OR = 2.2), and a lack of accelerations (OR = 5.2). All groups of infants with asphyxia were delivered operatively or instrumentally more often than were the matched control infants. No association was evident between asphyxia and maternal age, smoking, illnesses, time of delivery (day vs. night or seasonal), or previous cesarean delivery. Independent risk factors for HIE included intrauterine meconium release, CTG score, and operative delivery. This is one of the few population-based studies of risk factors for asphyxia and perhaps the first to separately examine risk factors for pure asphyxia, HIE, and asphyxia-related death and disability. Asphyxia was strongly associated with CTG abnormalities, particularly the absence of baseline variability. CTG monitoring definitely is indicated for women given oxytocin augmentation, one of the factors associated with asphyxia in this study.

Childbearing Beyond Age 40

In Brief Objective To examine pregnancy outcomes in women age 40 or older. Methods We used data from the California Health Information for Policy Project, which consists of linked records from the birth certificate and the hospital discharge record of both mother and newborn of all births that occurred in acute care civilian hospitals in California between January 1, 1992, and December 31, 1993. The study population consisted of all women who delivered at age 40 or over. The control population was women who delivered between age 20 and 29 years during this 2-year period. We reviewed gestational age at delivery, birth weight, mode and type of delivery, discharge summary and birth certificate demographics, birth outcome, pregnancy, and delivery data. Results Approximately 1,160,000 women delivered during the study period, and 24,032 (2%) of these women were age 40 or older. Of this latter group, 4777 (20%) were nulliparous. The cesarean delivery rate for nulliparous women in the study population was 47.0%, and the rate for multiparous patients in this group was 29.6%. The cesarean delivery rate was 22.5% for nulliparous and 17.8% for multiparous women in the control group. In the older group, the operative vaginal delivery rate (forceps and vacuum) was 14.2% for nulliparous women and 6.3% for multiparous women. Rates of birth asphyxia, fetal growth restriction, malpresentation, and gestational diabetes were significantly higher among older nulliparas (6, 2.5, 11, and 7%, respectively) compared with rates among control nulliparas (4, 1.4, 6, and 1.7%, respectively), and there were similar significant increases among older multiparas (3.4, 1.4, 6.9, and 7.8%, respectively), compared with younger multiparous controls (2.4, 1, 3.7, and 1.6%, respectively). Mean (± standard error) birth weight of infants delivered by older nulliparous women was 3201 ± 10 g, significantly lower than that among nulliparous controls (3317 ± 1 g), whereas mean birth weight in the group of older multiparas (3381 ± 5 g) was no different than that among younger multiparous controls (3387 ± 1 g). Gestational age at delivery was significantly lower among older nulliparas (273.4 ± 0.4 days), compared with nulliparous controls (278.5 ± 0.05 days), and similarly lower among older multiparous women (274.0 ± 0.2 days), compared with multiparous controls (278.3 ± 0.05 days). More white women age 40 or over than younger white women were having a first child (64 and 39%, respectively). Conclusion Nulliparous women age 40 or over have a higher risk of operative delivery (cesarean, forceps, and vacuum deliveries: 61%) than do younger nulliparous women (35%). This increase occurs in spite of lower birth weight and gestational age and may be explained largely by the increase in other complications of pregnancy. The increased frequency at which white women are having their first child at age 40 or over may reflect career choices that involve delaying childbirth until the fifth decade of life. These data will allow us better to counsel patients about their pregnancy expectations and possible outcomes. Childbirth after age 40 is associated with a significant operative delivery rate (61%) in nulliparous patients and increases in maternal and neonatal morbidity.

Childbearing beyond age 40: pregnancy outcome in 24,032 cases

Objective: To examine pregnancy outcomes in women age 40 or older. Methods: We used data from the California Health Information for Policy Project, which consists of linked records from the birth certificate and the hospital discharge record of both mother and newborn of all births that occurred in acute care civilian hospitals in California between January 1, 1992, and December 31, 1993. The study population consisted of all women who delivered at age 40 or over. The control population was women who delivered between age 20 and 29 years during this 2-year period. We reviewed gestational age at delivery, birth weight, mode and type of delivery, discharge summary and birth certificate demographics, birth outcome, pregnancy, and delivery data. Results: Approximately 1,160,000 women delivered during the study period, and 24,032 (2%) of these women were age 40 or older. Of this latter group, 4777 (20%) were nulliparous. The cesarean delivery rate for nulliparous women in the study population was 47.0%, and the rate for multiparous patients in this group was 29.6%. The cesarean delivery rate was 22.5% for nulliparous and 17.8% for multiparous women in the control group. In the older group, the operative vaginal delivery rate (forceps and vacuum) was 14.2% for nulliparous women and 6.3% for multiparous women. Rates of birth asphyxia, fetal growth restriction, malpresentation, and gestational diabetes were significantly higher among older nulliparas (6, 2.5, 11, and 7%, respectively) compared with rates among control nulliparas (4, 1.4, 6, and 1.7%, respectively), and there were similar significant increases among older multiparas (3.4, 1.4, 6.9, and 7.8%, respectively), compared with younger multiparous controls (2.4, 1, 3.7, and 1.6%, respectively). Mean (± standard error) birth weight of infants delivered by older nulliparous women was 3201 ± 10 g, significantly lower than that among nulliparous controls (3317 ± 1 g), whereas mean birth weight in the group of older multiparas (3381 ± 5 g) was no different than that among younger multiparous controls (3387 ± 1 g). Gestational age at delivery was significantly lower among older nulliparas (273.4 ± 0.4 days), compared with nulliparous controls (278.5 ± 0.05 days), and similarly lower among older multiparous women (274.0 ± 0.2 days), compared with multiparous controls (278.3 ± 0.05 days). More white women age 40 or over than younger white women were having a first child (64 and 39%, respectively). Conclusion: Nulliparous women age 40 or over have a higher risk of operative delivery (cesarean, forceps, and vacuum deliveries: 61%) than do younger nulliparous women (35%). This increase occurs in spite of lower birth weight and gestational age and may be explained largely by the increase in other complications of pregnancy. The increased frequency at which white women are having their first child at age 40 or over may reflect career choices that involve delaying childbirth until the fifth decade of life. These data will allow us better to counsel patients about their pregnancy expectations and possible outcomes.

Clinical Profile of Birth Asphyxia in Dhulikhel Hospital: A Retrospective Study

Introduction: Birth asphyxia is defined by the World Health Organization "the failure to initiate and sustain breathing at birth." The WHO has estimated that 4 million babies die during the neonatal period every year and 99% of these deaths occur in low-income and middle income countries. Three major causes account for over three quarters of these deaths, serious infection (28%) complication of preterm birth (26%) and birth asphyxia (23%). This estimation implies that birth asphyxia is the cause of around one million neonatal deaths each year. One of the present challenges is the lack of a gold standard for accurately defining birth asphyxia. Because of same reason the incidence of birth asphyxia is difficult to quantify. Objective: The aim of this study was to assess the prevalence of birth asphyxia, identify the common obstetric and neonatal risk factors, and study the cause of death. Methodology: All babies born in Dhulikhel Hospital (DH) from Jan 2007 to Oct 2009 with a diagnosis of birth asphyxia (5 min Apgar < 7 and those with no spontaneous respirations after birth) were included in the study (n=102). Clinical information was collected retrospectively from maternal records (maternal age, gravida, type of delivery, presence of meconium, induced or spontaneous labour, and pregnancy complications). The NICU records provided additional information about new born infant (birth asphyxia, stages of birth asphyxia, birth weight, sex and subsequent mortality). Results: Among the 3784 live births there were 102 babies with birth asphyxia prevalence of 26.9/1000 live births. Babies with Hypoxic ischemic encephalopathy (HIE) Stage 1 had a very good outcome but HIE III was associated with a poor outcome. Males, primipara and pregnancies with complications were associated with a higher rate of birth asphyxia. Septicaemia, necrotizing enterocolitis, preterm delivery, convulsion and, pneumothorax were associated with higher mortality and morbidity. Conclusion: Birth asphyxia was one of the commonest causes of admission and mortality in NICU. Babies with HIE Stage III had a very poor prognosis. Birth asphyxia combined with other morbidities was associated with a higher mortality. Sepsis is the commonest morbidity in cases of birth asphyxia. Maternal gravida, pregnancy complication with PROM, meconium, APH, emergency caesarean section, preterm and male sex were the risk factors for birth asphyxia. Key words: Birth asphyxia; HIE; Neonatal sepsisDOI: 10.3126/jnps.v30i3.3916J Nep Paedtr Soc 2010;30(3):141-146

Fetal Outcome in Deliveries with Meconium Stained Liquor

Introduction: Meconium staining amniotic fluid is associated with lots of adverseoutcome and has long been considered to be a bad predictor of fetal outcome.Objective: This prospective observational study was undertaken to find out immediatefetal outcome in meconium stained liquor.Materials and Methods: This study was conducted in Obstetrics and Gynecologydepartment of Dhaka National Medical Collage Hospital from July to December 2008.The pregnant women with yellow, brown and thinly stained amniotic fluid in labour withgestational age 37 completed weeks were enrolled in the study. Their babies weretaken as case and followed upto 7 days after delivery in National Medical CollageHospital and in Dhaka Shishu Hospital after admission when required. Babies bornwithout meconium stained liquor were taken as a control.Results: Total 80 cases were enrolled in the study as case and 80 cases wereenrolled as control. Mean gestational age was 39.3±1.5 weeks in cases and 38.5±1.3weeks in control. There was 13.8% pregnancy induced hypertension in case groupand 3.8% in control group. Pre-eclampsia were present 10% in case group and 1.1%in control group (p<0.05). Caesarean deliveries were high (75%) in cases and it wasmuch higher with thick meconium (75%) as compared to the thin meconium (25%,p<0.001). Apgar scores in first minute and fifth minute were also low in cases. Birthasphyxia was more in cases (20%). Meconium Aspiration syndrome (25%) andConvulsion (3.8%) were developed only in cases. Admission in neonatal ward wasmore (22.5%) in cases (p<0.05) as compared to control. Neonatal mortality was high(3.8%) in cases than control (1.3%).Conclusion: Meconium stained amniotic fluid were associated with higher rate ofcaesarian delivery, increased need for neonatal resuscitation, increased rate of birthasphyxia with hypoxic ischemic encephalopathy, meconium aspiration syndrome,hospital admission and mortality.Key words: Meconium stained liquor; foetal outcome.DOI: 10.3329/bjch.v33i2.5675Bangladesh Journal of Child Health 2009; Vol.33(2): 41-45