Intrapartum uterine activity and neonatal outcomes: a systematic review

Abstract

Background Increased uterine activity (UA) may not allow adequate recovery time for foetal oxygenation. Methods The aim of the study was to determine if increased UA during labour is associated with an increased risk of either short- or long-term neurological injury in term neonates, or with neonatal proxy measures of intrapartum hypoxia-ischemia. MEDLINE, CINAHL, and ClinicalTrials.gov were searched using the following terms: uterine activity, excessive uterine activity, XSUA, uterine hyperstimulation, and tachysystole. Any study that analysed the relationship between UA during term labour and neurological outcomes/selected proxy neurological outcomes was eligible for inclusion. Outcomes from individual studies were reported in tables and presented descriptively with odds ratios (OR) and 95% confidence intervals (CI) for dichotomous outcomes and means with standard deviations for continuous outcomes. Where group numbers were provided, ORs and their CIs were calculated according to Altman. Main results Twelve studies met the inclusion criteria. Seven studies featured umbilical artery pH as an individual outcome. Umbilical artery base excess and Apgar scores were both reported as individual outcomes in four studies. No study examined long term neurodevelopmental outcomes and only one study reported on encephalopathy as an outcome. The evidence for a relationship between UA and adverse infant outcomes was inconsistent. The reported estimated effect size varied from non-existent to clinically significant. Conclusions There is some evidence that increased UA may be a non-specific predictor of depressed neurological function in the newborn, but it is inconsistent and insufficient to support the conclusion that an association generally exists.

Uterine Tachysystole, Hypertonus and Hyperstimulation: An Urgent Need to get the Definitions Right to Avoid Intrapartum Hypoxic-Ischemic Brain Injury

“…The duration of the spiral artery compression depends on the strength and the duration of the contraction. In a recent systematic review by Reynolds et al, an increased uterine activity was found to be a non-specific predictor of depressed Global Journal of Reproductive Medicine neurological function in the newborn [1]. Similarly, it has been shown that six or more contractions in 10 minutes were significantly associated with fetal heart rate decelerations (P ≤ .001) [2].…”

First stage of labour duration and associated risk of adverse neonatal outcomes

“…Other factors need also to be considered in the context of studying labour duration; uterine contractions cause intermittent decreases in uteroplacental blood flow, resulting in temporarily reduced blood and oxygen delivery to the fetus 39 , 40 . Most fetuses tolerate these normal labour processes very well.…”

Particular features of labor activity at the presence of inflammation of the uterine layers and placental membranes

“…Слабкість пологової діяльності (СПД) спричиняє збільшення тривалості пологів, підвищує ризик оперативного вагінального розродження, кесаревого розтину та післяпологових кровотеч [3][4][5][6][7][8]. Надмірно сильна пологова діяльність або гіпертонічна дисфункція матки (ГДМ) має суттєвий негативний вплив як на матір (травми матки та пологових шляхів, емболія навколоплодовими водами, післяпологові кровотечі), так і на новонародженого (гіпоксія, внутрішньочерепні крововиливи, травми) [2,[8][9][10][11][12][13].…”