We investigated antepartum and intrapartum risk factors for neonatal encephalopathy (NE) in term infants. We performed a case-controlled study in which characteristics of singleton term infants who developed NE from 1993 to 2003 were compared with those of randomly selected controls. Antenatal risk factors (including obesity, diabetes, thyroid dysfunction, previous cesarean delivery, preeclampsia, fetal growth restriction, abnormal amniotic fluid volume, and abnormal fetal heart rate [FHR] tracing before labor) and intrapartum risk factors (acute intrapartum sentinel events and other risk factors like suspicious or ominous FHR tracing and clinical chorioamnionitis) were related to occurrence of NE. From the study cohort of 30,580 infants, 27 (0.09%) developed NE and were compared with 100 controls. Neonates with encephalopathy had more frequent antepartum (74% versus 18%, P < 0.001) and intrapartum (67% versus 19%, P < 0.001) risk factors, including acute intrapartum events (33% versus 2%, P < 0.001), than controls. On the whole, 26% of cases of NE had only antepartum risk factors, 22% had only intrapartum risk factors, and 44% had a combination of the two. In 2/27 (7%) cases, no risk factors were recognizable. In conclusion, 44% of cases of NE following term deliveries can be attributed to a combination of antepartum and intrapartum variables.

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BackgroundsMaternal total weight gain during pregnancy influences adverse obstetric outcomes in singleton pregnancies. However, its impact in twin gestation is less understood. Our objective was to estimate the influence of total maternal weight gain on preterm delivery in twin pregnancies.MethodsWe conducted a retrospective cohort study including diamniotic twin pregnancies with spontaneous labor delivered at 28 + 0 weeks or later. We analyzed the influence of total weight gain according to Institute of Medicine (IOM) cut-offs on the development of preterm delivery (both less than 34 and 37 weeks). Outcome were compared between under and normal weight gain and between over and normal weight gain separately using Fisher’s exact test with Holm-Bonferroni correction.ResultsOne hundred seventy five women were included in the study and divided into three groups: under (52.0%), normal (41.7%) and overweight gain (6.3%). Normal weight gain was associated with a reduction in the rate of preterm delivery compared to under and over weight gain [less than 34 weeks: under vs. normal OR 4.97 (1.76–14.02), over vs. normal OR 4.53 (0.89–23.08); less than 37 weeks: OR 3.16 (1.66–6.04) and 6.51 (1.30–32.49), respectively].ConclusionsNormal weight gain reduces spontaneous preterm delivery compared to over and underweight gain.

Prenatal sonographic features are related to postnatal outcome. Persistently isolated intra-abdominal calcifications have an excellent outcome. Delivery in a tertiary care center is recommended when calcifications are associated with other sonographic findings.

Background: The objective of our study was to evaluate the association between perinatal asphyxia and hypoxicischemic encephalopathy (HIE) with the presence of ante and intrapartum risk factors and/or abnormal fetal heart rate (FHR) findings, in order to improve maternal and neonatal management. Methods: We did a prospective observational cohort study from a network of four hospitals (one Hub center with neonatal intensive care unit and three level I Spoke centers) between 2014 and 2016. Neonates of gestational age ≥ 35 weeks, birthweight ≥1800 g, without lethal malformations were included if diagnosed with perinatal asphyxia, defined as pH ≤7.0 or Base Excess (BE) ≤ − 12 mMol/L in Umbical Artery (UA) or within 1 h, 10 min Apgar < 5, or need for resuscitation > 10 min. FHR monitoring was classified in three categories according to the American College of Obstetricians and Gynecologists (ACOG). Pregnancies were divided into four classes: 1) low risk; 2) antepartum risk; 3) intrapartum risk; 4) and both ante and intrapartum risk. In the first six hours of life asphyxiated neonates were evaluated using the Thomson score (TS): if TS ≥ 5 neonates were transferred to Hub for further assessment; if TS ≥ 7 hypothermia was indicated. Results: Perinatal asphyxia occurred in 21.5‰ cases (321/14,896) and HIE in 1.1‰ (16/14,896). The total study population was composed of 281 asphyxiated neonates: 68/5152 (1.3%) born at Hub and 213/9744 (2.2%) at Spokes (p < 0.001, OR 0.59, 95% CI 0.45-0.79). 32/213 (15%) neonates were transferred from Spokes to Hub. Overall, 12/281 were treated with hypothermia. HIE occurred in 16/281 (5.7%) neonates: four grade I, eight grade II and four grade III. Incidence of HIE was not different between Hub and Spokes. Pregnancies resulting in asphyxiated neonates were classified as class 1) 1.1%, 2) 52.3%, 3) 3.2%, and 4) 43.4%. Sentinel events occurred in 23.5% of the cases and FHR was category II or III in 50.5% of the cases. 40.2% cases of asphyxia and 18.8% cases of HIE were not preceded by sentinel events or abnormal FHR. Conclusions: We identified at least one risk factor associated with all cases of HIE and with most cases of perinatal asphyxia. In absence of risk factors, the probability of developing perinatal asphyxia resulted extremely low. FHR monitoring alone is not a reliable tool for detecting the probability of eventual asphyxia.