The risk of intrapartum/neonatal mortality and morbidity following birth at 37 weeks of gestation: a nationwide cohort study

Eskes, Martine; Ensing, Sabine; Groenendaal, Floris; Abu‐Hanna, Ameen; Ravelli, Anita C.J.

doi:10.1111/1471-0528.15748

Cited by 9 publications

(8 citation statements)

References 28 publications

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“…Our research reflects worse average values in the biochemical parameters of newborns at birth, and a higher percentage of acidosis in the normal gestational age range (37 to 41 gestational weeks inclusive) compared with the abnormal gestational age range (<37 or >41 weeks). This aligns with authors such as Parikh et al ( 18 ) and Sandström et al ( 19 ), with an increased rate of admission to intensive care units and higher respiratory morbidity in cases lying closer to gestational week 37, Eskes et al ( 20 ), Little et al ( 21 ), and Yi et al ( 17 ) reaffirm that birth at 37 gestational weeks is associated with a higher frequency of clinically relevant adverse perinatal outcomes. Term babies are more susceptible to mechanical injury and progressive hypoxic insults associated with prolonged and obstructed labor, which may often warrant operative intervention ( 17 ).…”

Section: Discussionsupporting

confidence: 85%

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Analysis of Factors Associated With Variability and Acidosis of the Umbilical Artery pH at Birth

2021

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Background: Perinatal asphyxia is a significant contributing factor for neonatal morbidity and mortality. The aim of this study was to investigate the clinical factors associated with umbilical artery pH variability and fetal acidosis at birth.Methods: This is a single center cross-sectional study in a public regional hospital in southeastern Spain from January to December 2019. The reference population was 1.655 newborns, final sample of 312 experimental units with validated values of umbilical cord blood pH.Results: Factors such as gestational age at term (X̄at-term: 7.26 ± 0.08-X̄no-at−term: 7.31 ± 0.05, p: 0.00), primiparity (X̄primiparity: 7.24 ± 0.078-X̄multiparity: 7.27 ± 0.08, p: 0.01), induced labor (X̄induced: 7.24 ± 0.07-X̄spontaneous: 7.26 ± 0.081, p: 0.02), vaginal delivery (X̄vaginal:7.25 ± 0.08-X̄cesarean:7.27 ± 0.07, p: 0.01), and prolonged dilation duration (X̄AboveAverage: 7.22 ± 0.07-X̄BelowAverage: 7.27 ± 0.08, p: 0.00), expulsion duration (X̄AboveAverage: 7.23 ± 0.07-X̄BelowAverage: 7.26 ± 0.08, p: 0.01), and total labor duration (X̄AboveAverage: 7.23 ± 0.07-X̄BelowAverage: 7.27 ± 0.08, p: 0.00) are associated with a decrease in umbilical artery pH at birth. However, only three factors are associated with acidosis pH (<7.20) of the umbilical artery at birth: the induction of labor [OR: 1.74 (95% CI: 0.98–3.10); p: 0.04], vaginal delivery [OR: 2.09 (95% CI: 0.95–4.61); p: 0.04], and total duration of labor [OR: 2.06 (95% CI: 1.18–3.57); p: 0.01].Conclusions: Although several factors may affect the variability of umbilical artery pH at birth by decreasing their mean values (gestational age, primiparity, induced labor, vaginal delivery and prolonged: dilation duration, expulsion duration and total labor duration), only induction of labor, vaginal delivery and total duration of labor are associated with an acidosis (<7.20) of same.

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Section: Discussionsupporting

confidence: 85%

“…Of the 312 infants constituting the sample, 30.7% (96) presented acidotic pH of the umbilical artery at birth, 79.2% (76) showed respiratory acidosis, and 20.8% (20) showed mixed acidosis (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Analysis of Factors Associated With Variability and Acidosis of the Umbilical Artery pH at Birth

2021

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“…17 Delivery at or after 38-39 weeks' gestation carries the same risk of intrapartum stillbirth and neonatal death as delivery at a later week of gestation. 17,198 These epidemiological observations underlie the 67% reduction in the risk of perinatal death associated with IOL at term. 16…”

Section: Candidate Primary Outcomesmentioning

confidence: 95%

Universal late pregnancy ultrasound screening to predict adverse outcomes in nulliparous women: a systematic review and cost-effectiveness analysis

Smith

Moraitis

Wastlund

et al. 2021

Health Technol Assess

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Background Currently, pregnant women are screened using ultrasound to perform gestational aging, typically at around 12 weeks’ gestation, and around the middle of pregnancy. Ultrasound scans thereafter are performed for clinical indications only. Objectives We sought to assess the case for offering universal late pregnancy ultrasound to all nulliparous women in the UK. The main questions addressed were the diagnostic effectiveness of universal late pregnancy ultrasound to predict adverse outcomes and the cost-effectiveness of either implementing universal ultrasound or conducting further research in this area. Design We performed diagnostic test accuracy reviews of five ultrasonic measurements in late pregnancy. We conducted cost-effectiveness and value-of-information analyses of screening for fetal presentation, screening for small for gestational age fetuses and screening for large for gestational age fetuses. Finally, we conducted a survey and a focus group to determine the willingness of women to participate in a future randomised controlled trial. Data sources We searched MEDLINE, EMBASE and the Cochrane Library from inception to June 2019. Review methods The protocol for the review was designed a priori and registered. Eligible studies were identified using keywords, with no restrictions for language or location. The risk of bias in studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Health economic modelling employed a decision tree analysed via Monte Carlo simulation. Health outcomes were from the fetal perspective and presented as quality-adjusted life-years. Costs were from the perspective of the public sector, defined as NHS England, and the costs of special educational needs. All costs and quality-adjusted life-years were discounted by 3.5% per annum and the reference case time horizon was 20 years. Results Umbilical artery Doppler flow velocimetry, cerebroplacental ratio, severe oligohydramnios and borderline oligohydramnios were all either non-predictive or weakly predictive of the risk of neonatal morbidity (summary positive likelihood ratios between 1 and 2) and were all weakly predictive of the risk of delivering a small for gestational age infant (summary positive likelihood ratios between 2 and 4). Suspicion of fetal macrosomia is strongly predictive of the risk of delivering a large infant, but it is only weakly, albeit statistically significantly, predictive of the risk of shoulder dystocia. Very few studies blinded the result of the ultrasound scan and most studies were rated as being at a high risk of bias as a result of treatment paradox, ascertainment bias or iatrogenic harm. Health economic analysis indicated that universal ultrasound for fetal presentation only may be both clinically and economically justified on the basis of existing evidence. Universal ultrasound including fetal biometry was of borderline cost-effectiveness and was sensitive to assumptions. Value-of-information analysis indicated that the parameter that had the largest impact on decision uncertainty was the net difference in cost between an induced delivery and expectant management. Limitations The primary literature on the diagnostic effectiveness of ultrasound in late pregnancy is weak. Value-of-information analysis may have underestimated the uncertainty in the literature as it was focused on the internal validity of parameters, which is quantified, whereas the greatest uncertainty may be in the external validity to the research question, which is unquantified. Conclusions Universal screening for presentation at term may be justified on the basis of current knowledge. The current literature does not support universal ultrasonic screening for fetal growth disorders. Future work We describe proof-of-principle randomised controlled trials that could better inform the case for screening using ultrasound in late pregnancy. Study registration This study is registered as PROSPERO CRD42017064093. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 15. See the NIHR Journals Library website for further project information.

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“…Child factors included child sex (male/female), gestational age (weeks) and birthweight (grams). Standard cutoffs for prematurity were applied to gestational age (≥ 37 weeks/<37 weeks) and birthweight (≥ 2500 g/<2500 g) as per clinical standards of falling within the 10th percentile of pregnancies, with increased infant mortality risk [ 29 , 30 ]. Maternal and socioeconomic factors included maternal age at birth, maternal education, maternal history of smoking, maternal psychiatric history, and deprivation indices.…”

Section: Methodsmentioning

confidence: 99%

Maternal infections during pregnancy and child cognitive outcomes

Kwok

Hall

Murray

et al. 2022

BMC Pregnancy Childbirth

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Background Maternal prenatal infections have been linked to children’s neurodevelopment and cognitive outcomes. It remains unclear, however, whether infections occurring during specific vulnerable gestational periods can affect children’s cognitive outcomes. The study aimed to examine maternal infections in each trimester of pregnancy and associations with children’s developmental and intelligence quotients. The ALSPAC birth cohort was used to investigate associations between maternal infections in pregnancy and child cognitive outcomes. Methods Infection data from mothers and cognition data from children were included with the final study sample size comprising 7,410 mother-child participants. Regression analysis was used to examine links between maternal infections occurring at each trimester of pregnancy and children’s cognition at 18 months, 4 years, and 8 years. Results Infections in the third trimester were significantly associated with decreased verbal IQ at age 4 (p < .05, adjusted R2 = 0.004); decreased verbal IQ (p < .01, adjusted R2 = 0.001), performance IQ (p < .01, adjusted R2 = 0.0008), and total IQ at age 8 (p < .01, adjusted R2 = 0.001). Conclusion Results suggest that maternal infections in the third trimester could have a latent effect on cognitive development, only emerging when cognitive load increases over time, though magnitude of effect appears to be small. Performance IQ may be more vulnerable to trimester-specific exposure to maternal infection as compared to verbal IQ. Future research could include examining potential mediating mechanisms on childhood cognition, such as possible moderating effects of early childhood environmental factors, and if effects persist in future cognitive outcomes.

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The risk of intrapartum/neonatal mortality and morbidity following birth at 37 weeks of gestation: a nationwide cohort study

Cited by 9 publications

References 28 publications

Analysis of Factors Associated With Variability and Acidosis of the Umbilical Artery pH at Birth

Analysis of Factors Associated With Variability and Acidosis of the Umbilical Artery pH at Birth

Universal late pregnancy ultrasound screening to predict adverse outcomes in nulliparous women: a systematic review and cost-effectiveness analysis

Maternal infections during pregnancy and child cognitive outcomes

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