Affiliation:
1. Academic Department of Obstetrics and Gynaecology Imperial College London, Chelsea and Westminster Hospital London UK
2. The Royal College of Obstetricians and Gynaecologists London UK
3. Department of Women's Health North Bristol NHS Trust Westbury on Trym UK
4. Department of Public Health and Primary Care University of Cambridge, Strangeways Research Laboratory Cambridge UK
5. Department of Public Health and Primary Care / Cardiovascular Epidemiology Unit, Victor Phillip Dahdaleh Heart and Lung Research Institute University of Cambridge Cambridge UK
6. Health Data Research UK Cambridge Wellcome Genome Campus and University of Cambridge Cambridge UK
Abstract
AbstractObjectiveTo 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.DesignObservational prospective cohort study.Setting17 UK maternity units.Sample585 291 pregnancies between 1988 and 2000 inclusive.MethodsAdjusted odds ratios (OR) with 95% confidence intervals (95% CI) were estimated from multivariable logistic regression.Main outcome measuresAdverse 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).ResultsAnalysis 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.ConclusionsA 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.
Funder
British Heart Foundation
NIHR Cambridge Biomedical Research Centre
Subject
Obstetrics and Gynecology
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