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Observational Study
. 2023 Nov;130(12):1521-1530.
doi: 10.1111/1471-0528.17531. Epub 2023 May 8.

Risk factors for a serious adverse outcome in neonates: a retrospective cohort study of vaginal births

Sita Jindal  1 , Philip J Steer  1 , Makrina Savvidou  1 , Tim Draycott  2   3 , Mary Dixon-Woods  4 , Angela Wood  5   6 , Lois G Kim  5
Affiliations
Observational Study

Risk factors for a serious adverse outcome in neonates: a retrospective cohort study of vaginal births

Sita Jindal et al. BJOG. 2023 Nov.

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.

Keywords: fetal deterioration; intrapartum fetal monitoring; labour outcome; meconium; pyrexia; risk factors.

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Conflict of interest statement

PJS is the medical director and a shareholder in CaretekMedical, a company that has produced a smartphone app for women to assess their antenatal risk factors (http://www.caretekmedical.net/). Details of his additional interests can be found at https://obgyn.onlinelibrary.wiley.com/hub/journal/14710528/editors‐disclosures‐of‐interests#Philip_Steer. LK is funded by the NIHR BTRU in Donor Health and Behaviour (NIHR203337) and a BHF Chair award (CH/12/2/29428). This work was performed using resources provided by the Cambridge Service for Data Driven Discovery (CSD3) operated by the University of Cambridge Research Computing Service (www.csd3.cam.ac.uk), provided by Dell EMC and Intel using Tier‐2 funding from the Engineering and Physical Sciences Research Council (capital grant EP/P020259/1), and DiRAC funding from the Science and Technology Facilities Council (www.dirac.ac.uk). TJD was at the time of the work described in this paper the Vice‐President (clinical quality) of the Royal College of Obstetricians and Gynaecologists. SJ, MS, AW have no interests to declare.

Figures

FIGURE 1
FIGURE 1
Adjusted odds ratios in women not undergoing emergency caesarean section (complete data, n = 302 137) for (A) 5‐minute Apgar <7 and (B) composite poor outcome. Variable definitions are listed in Figure S2.
FIGURE 2
FIGURE 2
Adjusted odds ratios in women not undergoing emergency caesarean section (imputed data, n = 397 984) for (A) 5‐minute Apgar <7 and (B) composite poor outcome. Variable definitions are listed in Figure S2.
See this image and copyright information in PMC

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