Neonatal Asphyxia. I. Relationship of Obstetric and Neonatal Complications to Neonatal Mortality in 38,405 Consecutive Deliveries

Macdonald, Hugh; Mulligan, John C.; Allen, Alexander C.; Taylor, Paul

doi:10.1097/00006254-198102000-00014

Cited by 115 publications

(31 citation statements)

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“…Prior to widespread prenatal diagnosis of trisomy 18, about half the cases delivered by C-section [Bergin et al, 1988;David and Glew, 1980;Inagaki et al, 1987;Young et al, 19861. Currently, it is a somewhat controversial recommendation not to do a C-section for fetal distress in a pregnancy with trisomy 18 [Benacerraf et al, 1988;Bergin et al, 1988;Bundy et al, 1986;Karp and Meis, 1977;MacDonald et al, 1980;Schneider et al, 19811. The justification is that the procedure increases maternal mortality and morbidity somewhat, and that the procedure does not benefit the baby.…”

Section: Deliverymentioning

confidence: 99%

Natural history of trisomy 18 and trisomy 13: I. Growth, physical assessment, medical histories, survival, and recurrence risk

Baty¹,

Blackburn²,

Carey³

1994

Am. J. Med. Genet.

267

224

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The natural history of trisomy 18 and trisomy 13 was investigated using data derived from parent questionnaires and medical records from 98 families with an index case of trisomy 18 and 32 families with an index case of trisomy 13. Data are presented on pregnancy, delivery, survival, medical complications, immunizations, growth, cause of death, cytogenetics, and recurrence risk. Half of the trisomy 18 babies were delivered by C-section. Fetal distress was a factor in half, and the only reason in a third of C-section deliveries. One minute Apgar scores were significantly lower in C-section and breech deliveries. There were more small for gestational age babies than in the general population, but most of the low birth weight newborns were small for gestational age, unlike the general population. Survival in this group of children was better than in other studies due to ascertainment bias. There were more girls than boys at all ages for both conditions, and the sex ratio decreased with time. Growth curves for length, weight, head circumference, and weight vs height are provided. Long-term survival did not appear to be due to mosaicism. We found no adverse reactions attributable to immunizations. At age 1 year there was an average of approximately 2 operations per living child. We report the second case of successful major cardiac surgery in a trisomy 18 child. Almost 70% of deaths were attributed to cardiopulmonary arrest. The sibling recurrence risk for trisomy 18 or trisomy 13 was 0.55%.

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Section: Deliverymentioning

confidence: 99%

Natural history of trisomy 18 and trisomy 13: I. Growth, physical assessment, medical histories, survival, and recurrence risk

Baty¹,

Blackburn²,

Carey³

1994

Am. J. Med. Genet.

267

224

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“…Birth asphyxia is a perinatal event, in serious cases leading to a dismal outcome with risk of death or permanent sequelae. Its incidence may be influ-enced by the same risk factors as detailed earlier or by unexpected catastrophic events, as well as by a combination of the two (4)(5)(6)(7)(8)(9).…”

mentioning

confidence: 95%

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

Milsom¹,

Ladfors²,

Thiringer³

et al. 2003

Obstetrical & Gynecological Survey

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Background. The influence of maternal, obstetric and fetal risk factors on the prevalence of birth asphyxia at term in a Swedish urban population. Objective. To investigate risk factors for Apgar score-defined birth asphyxia, birth asphyxia with hypoxic-ischemic encephalopathy and birth asphyxia-related death/disability. Material and methods. Retrospective case-control study in term neonates with birth asphyxia defined as Apgar score Ͻ7 at 5 min. Cases originating from nonasphyctic causes (e.g. infection, maternal sedation) were excluded. Hypoxic-ischemic encephalopathy was diagnosed according to criteria by Sarnat. Maternal, obstetric and fetal risk factors were registered in 225 cases of birth asphyxia diagnosed in 42 203 live births occurring in the urban Swedish population studied. A matched control group was used for statistical evaluation. Results. Asphyxia was associated with single civil status, OR Ω 7.1 (95%CI 2.0, 27.6); intrauterine meconium release, OR Ω 4.1 (95%CI 1.8, 9.8); operative delivery, OR Ω 8.7 (95%CI 3.4, 24.6); breech delivery, OR Ω 20.3 (95%CI 3.0, 416.5); oxytocin augmentation, OR Ω 2.9 (95%CI 1.4, 6.3); cord complication, OR Ω 15.8 (95%CI 2.1, 341.5); external compression to assist delivery OR Ω 6.2 (95%CI 1.3, 45.7); and cardiotocography score, OR Ω 0.5 (95%CI 0.4, 0.6). Normal fetal heart rate variability, OR Ω 0.4 (95%CI 0.2, 0.6), repeated late decelerations irrespective of amplitude or repeated variable decelerations, OR Ω 29.4 (95%CI 5.7, 540.8) or occasional late or variable decelerations, OR Ω 2.2 (95%CI 1.3, 3.8), and no accelerations, OR Ω 5.2 (95%CI 2.0, 16.4), were associated with asphyxia. Operative or instrumental delivery was more common in all three asphyxia groups compared with controls. Leanness was a risk factor for asphyxia and for hypoxic-ischemic encephalopathy. Maternal age, smoking and illnesses, time of delivery (day/night, seasonal) and previous caesarean section were not associated with birth asphyxia.Conclusions. An association between neonatal asphyxia and cardiotocography parameters, intrauterine meconium release, operative delivery, breech delivery, single civil status, oxytocin augmentation, cord complication, external compression to assist delivery and neonatal leanness was found. Abnormal fetal heart rate variability, repeated late decelerations irrespective of amplitude or repeated variable decelerations, occasional late or variable decelerations and no accelerations were associated with asphyxia.

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“…The safest way for a breech fetus to be born is still under discussion (13,(18)(19)(20)(21). Although our study was not a randomized clinical trial, our data indicate that-at least in our institution-caesarean section is probably the best way for a fetus with breech presentation to be delivered.…”

Section: Discussionmentioning

confidence: 70%

Mortality in the First Week of Life and Mode of Delivery

Corchia¹,

Paone²

1985

Acta Paediatrica

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11 923 singletons with birthweight greater than 775 g born consecutively at the 2nd School of Medicine of Naples during a four-year period (November 1975 to October 1979) were the subjects of the study. Mortality in the first week of life was 10.9, 9.7, 6.7 and 10.7 per 1 000 respectively in the four years. The total variability of the crude death rates was reduced by 21.4% after standardization for birthweight distribution alone and by 28.6% when both birthweight and mode of delivery were taken into account. Therefore only a small fraction of the variations in mortality can be ascribed to changes in the distribution of modes of delivery during the study period. Most of these variations are probably related to the quality of perinatal care, which seems to have improved only for babies under 1 526 g. Birthweight specific mortality in relation to mode of delivery is further discussed.

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Neonatal Asphyxia. I. Relationship of Obstetric and Neonatal Complications to Neonatal Mortality in 38,405 Consecutive Deliveries

Cited by 115 publications

References 0 publications

Natural history of trisomy 18 and trisomy 13: I. Growth, physical assessment, medical histories, survival, and recurrence risk

Natural history of trisomy 18 and trisomy 13: I. Growth, physical assessment, medical histories, survival, and recurrence risk

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

Mortality in the First Week of Life and Mode of Delivery

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