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Obstetric emergencies as antecedents to neonatal hypoxic ischemic encephalopathy, does parity matter?
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
2018 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 11, p. 1396-1404Article in journal (Refereed) Published
Abstract [en]

Introduction: Our aim was to investigate the risk of moderate to severe hypoxic ischemic encephalopathy (HIE) by obstetric emergencies, with focus on the distribution of obstetric emergencies by parity, taking the history of a previous cesarean into account.

Material and methods: Population-based cohort study of 692 428 live births at >= 36 weeks of gestation in Sweden, 2009-2015. Data were retrieved by linking the Swedish Medical Birth Register with the Swedish Neonatal Quality Register. Therapeutic hypothermia served as surrogate for moderate to severe HIE. Logistic regression analysis was used to estimate associations between HIE and placental abruption, eclampsia, cord prolapse, uterine rupture, and shoulder dystocia, presented as adjusted odds ratios (aORs) with 95% CI.

Results: An obstetric emergency occurred in 133/464 (29%) of all HIE cases, more commonly in the parous (overall 37%; 48% with and 31% without a previous cesarean) than in the nulliparous (21%). Among nulliparas, shoulder dystocia was the most common obstetric emergency with the strongest association with HIE (aOR 48.2; 95% CI 28.2-82.6). In parous women without a previous cesarean, shoulder dystocia was most common, but placental abruption had the strongest association with HIE. Among parous women with a previous cesarean, uterine rupture was the most prevalent obstetric emergency with the strongest association with HIE (aOR 45.6; 95% CI 24.5-84.6).

Conclusions: Obstetric emergencies are common among cases of moderate to severe HIE. The strong association with shoulder dystocia in nullipara, and with uterine rupture in women with previous cesarean deliveries, implies an opportunity for reducing the incidence of HIE.

Place, publisher, year, edition, pages
2018. Vol. 97, no 11, p. 1396-1404
Keywords [en]
Asphyxia, hypoxic ischemic encephalopathy, obstetric emergencies, parity, risk factors, therapeutic hypothermia
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:uu:diva-341718DOI: 10.1111/aogs.13423ISI: 000446155300016PubMedID: 29978451OAI: oai:DiVA.org:uu-341718DiVA, id: diva2:1182385
Funder
Swedish Research Council, 2014-3561Swedish Research Council, 2012-00087
Note

Title in dissertation reference list: Obstetric emergencies as antecedents to neonatal hypoxic ischemic encephalopathy, does parity matter? : a Swedish national cohort study

Available from: 2018-02-13 Created: 2018-02-13 Last updated: 2018-11-28Bibliographically approved
In thesis
1. Birth asphyxia: Fetal scalp blood sampling and risk factors for hypoxic ischemic encephalopathy
Open this publication in new window or tab >>Birth asphyxia: Fetal scalp blood sampling and risk factors for hypoxic ischemic encephalopathy
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Preventing birth asphyxia is a major challenge in delivery care. The aims of this thesis were to evaluate fetal scalp blood sampling (FBS) and explore risk factors for moderate to severe neonatal hypoxic ischemic encephalopathy (HIE).

In a study of 241 deliveries monitored by FBS, a discrepancy between pH and lactate (one abnormal and one normal value) was common (55%) in combined FBS. We found that the frequency of operative deliveries for fetal distress (ODFD) was lower when both pH and lactate were analysed in FBS compared with analysis of only pH or lactate, without affecting neonatal outcome. (Study I)

In a questionnaire study, women (n = 51) monitored by FBS generally tolerated the test well. Women without epidural, with higher body mass index (BMI), and with less cervical dilatation had higher pain ratings compared with their counterparts. The obstetricians that performed the test generally experienced the test as easy to perform, but more complicated with high maternal BMI, less cervical dilatation, and higher station of the fetal head. (Study II)

In a national cohort of 692 428 live births ≥ 36 weeks, risk factors for moderate to severe HIE were identified. We found a linear association between increasing maternal BMI and decreasing maternal height and risk of HIE. Compared with non-short (≥156 cm) and normal weight (BMI<25 kg/m2) women, short and overweight women had a threefold risk of HIE. (Study III)

Obstetric emergencies occurred in 29% of HIE cases, more commonly in parous (37%) than in nulliparous (21%) women. Among nulliparous women, shoulder dystocia was most common, with the strongest association to HIE. In parous women without previous caesarean, shoulder dystocia was most common, but placental abruption had the strongest association to HIE. Among parous women with previous caesarean, uterine rupture was the most prevalent, with the strongest association to HIE. (Study IV)

Conclusions: Combined FBS might decrease the frequency of ODFD. FBS is well tolerated in women and generally uncomplicated for the obstetrician to perform. Women with short stature and overweight have increased risk of having an infant with HIE. Obstetric emergencies are common underlying causes of HIE, especially in parous women.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 81
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1435
Keywords
asphyxia, fetal scalp blood sampling, hypoxic ischemic encephalopathy, obstetric emergencies, operative deliveries for fetal distress, overweight, short stature
National Category
Medical and Health Sciences
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-340782 (URN)978-91-513-0250-8 (ISBN)
Public defence
2018-04-26, Rosénsalen, Ing 95/96, Akademiska sjukhuset, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2018-04-03 Created: 2018-02-17 Last updated: 2018-04-24

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Liljeström, LenaJonsson, MariaWikström, Anna-Karin

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