Chances of Adverse Neonatal Outcome in High-Risk and Low-Risk Obstetrical Patients

Abstract

Objective: To analyze and compare occurrence of adverse immediate neonatal outcomes in high and low-risk obstetrical population. Methods:Retrospective cohort study of 2370 pregnant women.The odds of adverse outcomes (i.e. low Apgar score (1-4 points) and intermediate Apgar score (5-8 points) at 1 and 5 minutes of life, birth to a small-for-gestational-age neonate (below 90th percentile of birth weight), and requirement for advanced level II-III nursery care) as well as odds of primary cesarean delivery-were analyzed using logistic regression analysis.Results: All of the studied outcomes were seen more often among the high-risk patients.When the outcomes were analyzed within a given group some interesting observations were made.The highest odds of abnormal Apgar scores (when compared to the low risk population) were seen in patients with preeclampsia-6.06 (95% CI 3.28; 11.22) and twin pregnancies-odds ratio of 6.63 (95% CI 2.24; 19.67).Among Small-for-Gestational-Age newborns the most frequently identifi ed maternal condition was preeclampsia (21.57%), out of all fetal conditions twin gestation (26.67%) was number one identifi ed scenario.The highest proportion of patients requiring advanced level nursery care (level II and III) was observed in those with twin gestation, pregnancies complicated by hypertension with and without diabetes.The highest odds of having primary cesarean delivery in laboring patients (when compared to the low risk population) were seen in the patients with IUGR fetus-odds ratio of 26.78 [95% CI 7.65; 93.75], followed by macrosomia-odds ratio 5.74 [95% CI 2.14; 15.41], preeclampsia-odds ratio 5.52 [95% CI 3.14; 9.69].For additional fi ndings and more information on select conditions, please, refer to the full-text article. Conclusion:The studied outcomes are useful markers of fetal/neonatal status and can be used to compare perinatal outcomes between different medical conditions, different locales and to assess the dynamics of fetal/neonatal well-being over the course of time.Level of Evidence: II Detailed information on the studied adverse neonatal outcomes can be found in the full-text version of this document.

Determinants of low APGAR score among preeclamptic deliveries in Cipto Mangunkusumo Hospital: a retrospective cohort study in 2014

“…1,3 The various complication seen are low appearance, pulse, grimace, activity, respiration (APGAR) score, intra-uterine growth restriction (IUGR), low birth weight, and increased need for admission to neonatal intensive care unit (NICU). 4,5 The APGAR score, devised in 1952 by Dr. Virginia Apgar, is a quick method of assessing the clinical status of the newborn infant. 6, The APGAR score comprises of five components: heart rate, respiratory effort, muscle tone, reflex irritability, and color, each of which is given a score of zero, one, or two.…”

Clinical evaluation of anesthesia for cesarean section at tertiary medical center: retrospective study for 5 years (2009-2013)

“…Krilova [6] reported that when low Apgar scores, birth to a small-for-gestational-age neonate, and a requirement for advanced level nursery care of neonates born to a high-risk mother and a non-high-risk mother were compared, those born to high-risk This study included 1,037 persons (91.2%) who received general anesthesia for cesarean sections in our hospital, which accounted for more persons than received regional anesthesia.…”

“…Malinow and Ostheimer [5] regarded a parturient with preeclampsia/eclampsia, diabetes, premature birth, multiple gestation, infectious disease, existing neurological or cardiac disorder as a high-risk parturient; while Krilova [6] included existing or pregnancy-related medical conditions that are known to increase risk to the fetus, preeclampsia, diabetes, placenta previa, multiple gestation, intrauterine growth retardation, oligohydramnios and breech presentation. The current study decided to use the term high-risk delivery as a concept that included the risks to the mother, the fetus, and the delivery itself; and high-risk delivery was defined according to the six risk factors mentioned above.…”

Clinical evaluation of anesthesia for high-risk cesarean section at a tertiary medical center: retrospective study for 8 years (2009–2016)

“…However, qualifying criteria for high-risk pregnancy vary between studies. [3][4][5] Malinow and Ostheimer 3 defined high-risk mothers as those with preeclampsia/eclampsia, diabetes, premature labor, multiple pregnancy, infectious disease, or existing neurological or cardiac disorders. Krilova's 4 definition included existing or pregnancy-related medical conditions that posed a likely risk to the fetus, preeclampsia, diabetes, placenta previa, multiple pregnancy, intrauterine growth retardation, oligohydramnios, and breech presentation.…”

“…[3][4][5] Malinow and Ostheimer 3 defined high-risk mothers as those with preeclampsia/eclampsia, diabetes, premature labor, multiple pregnancy, infectious disease, or existing neurological or cardiac disorders. Krilova's 4 definition included existing or pregnancy-related medical conditions that posed a likely risk to the fetus, preeclampsia, diabetes, placenta previa, multiple pregnancy, intrauterine growth retardation, oligohydramnios, and breech presentation. In this study, we used the term "high-risk delivery" as a concept, including the risks to the mother, fetus, and during delivery, with the definition based on the following six risk factors: 1) any form of hypertension during pregnancy (chronic hypertension, gestational hypertension, preeclampsia, superimposed preeclampsia, or eclampsia); 2) peripartum hemorrhage (placental abruption or placental abnormality); 3) multiple gestations; 4) underlying maternal disease (cardiovascular, renal, hematological, respiratory, neural, or infectious diseases); 5) cases in which emergency cesarean section was necessary (fetal distress, prolapse of the umbilical cord, or uterine rupture); and 6) advanced maternal age (35 years or older).…”