Objectives: to assess labour characteristics in relation to the occurrence of Composite Adverse neonatal Outcome (CAO) within a cohort of fetuses with metabolic acidaemia. Design: retrospective cohort study. Setting: 3 Italian tertiary maternity units. Population: 431 neonates born with acidaemia ≥36 weeks. Methods: Intrapartum CTG traces were assigned to one of these four types of labour hypoxia: acute, subacute, gradually evolving and chronic hypoxia. The presence of CAO was defined by the occurrence of at least one of the following: Sarnat Score grade ≥2, seizures, hypothermia and death <7 days from birth. Main outcome measures: to compare the type of hypoxia on the intrapartum CTG traces among the acidaemic neonates with and without CAO. Results: The occurrence of a CAO was recorded in 15.1% of neonates. At logistic regression analysis, the duration of the hypoxia was the only parameter associated with CAO in case of acute and subacute pattern (OR 1.3; 95% CI 1.02-1.6 and OR 1.04; 95% CI 1.0-1.1), while the duration of the hypoxic insult and the time from PROM to delivery were both associated with CAO in those with gradually evolving pattern (OR 1.13; 95% CI 1.01-1.3 and OR 1.04; 95% CI 1.0-1.7). The incidence of CAO was higher in fetuses with chronic antepartum hypoxia compared to those showing CTG features of intrapartum hypoxia (64.7 vs. 13.0%; p<0.001). Conclusions: The frequency of CAO seems related to the duration and the type of the hypoxic injury being higher in fetuses showing CTG features of antepartum chronic hypoxia.
Short term morbidity and types of intrapartum hypoxia in the newborn with metabolic acidaemia: a retrospective cohort study
Paolucci, S;Cromi, A;
2022-01-01
Abstract
Objectives: to assess labour characteristics in relation to the occurrence of Composite Adverse neonatal Outcome (CAO) within a cohort of fetuses with metabolic acidaemia. Design: retrospective cohort study. Setting: 3 Italian tertiary maternity units. Population: 431 neonates born with acidaemia ≥36 weeks. Methods: Intrapartum CTG traces were assigned to one of these four types of labour hypoxia: acute, subacute, gradually evolving and chronic hypoxia. The presence of CAO was defined by the occurrence of at least one of the following: Sarnat Score grade ≥2, seizures, hypothermia and death <7 days from birth. Main outcome measures: to compare the type of hypoxia on the intrapartum CTG traces among the acidaemic neonates with and without CAO. Results: The occurrence of a CAO was recorded in 15.1% of neonates. At logistic regression analysis, the duration of the hypoxia was the only parameter associated with CAO in case of acute and subacute pattern (OR 1.3; 95% CI 1.02-1.6 and OR 1.04; 95% CI 1.0-1.1), while the duration of the hypoxic insult and the time from PROM to delivery were both associated with CAO in those with gradually evolving pattern (OR 1.13; 95% CI 1.01-1.3 and OR 1.04; 95% CI 1.0-1.7). The incidence of CAO was higher in fetuses with chronic antepartum hypoxia compared to those showing CTG features of intrapartum hypoxia (64.7 vs. 13.0%; p<0.001). Conclusions: The frequency of CAO seems related to the duration and the type of the hypoxic injury being higher in fetuses showing CTG features of antepartum chronic hypoxia.
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