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- Title
Intrapartum fetal monitoring and perinatal risk factors of neonatal hypoxic–ischemic encephalopathy.
- Authors
Michaeli, Jennia; Srebnik, Naama; Zilberstein, Zvi; Rotem, Reut; Bin-Nun, Alona; Grisaru-Granovsky, Sorina
- Abstract
Background: Neonatal hypoxic–ischemic encephalopathy (HIE) in term infants, is a major cause of neonatal mortality and severe neurologic disability. Objectives: To identify in labor fetal monitoring characteristic patterns and perinatal factors associated with neonatal HIE. Study design: Single-center retrospective case–control study between 2010 and 2017. Cases clinically diagnosed with neonatal HIE treated by therapeutic hypothermia according to strict criteria (HIE-TH) were compared to a group of neonates born in the same period, gestational age-matched diagnosed with fetal distress according to fetal monitoring interpretation that was followed by prompt delivery, without subsequent HIE or therapeutic hypothermia (No-HIE). The primary outcome of the study was the electronic fetal monitoring (EFM) pattern during 60 min prior to delivery; the secondary outcome was the identification of perinatal associated factors. Results: 54 neonates with HIE were treated by therapeutic hypothermia. EFM parameters most predictive of HIE-TH were indeterminate baseline heart rate OR = 47.297, 95% (8.17–273.76) p < 0.001, bradycardia OR = 15.997 95% (4.18–61.18) p < 0.001, low variability OR = 10.224, 95% (2.71–38.45) p < 0.001, higher baseline of the fetal heart rate calculated for each increment of 1 BPM OR = 1.0547, 95% (1.001–1.116) p = 0.047. Rupture of a previous uterine cesarean scar and placental abruption were characteristic of the HIE-TH group 14.8% vs. 1% p < 0.05; and 16.7% vs. 6% p < 0.05, respectively. Adverse neonatal outcomes also differed significantly: HIE-TH had a higher rate of neonatal seizures 46.2% vs. 0% p < 0.001 and mortality 7.7% vs. 0% p < 0.001. Conclusions: Characteristic fetal monitoring pattern prior to delivery together with acute obstetric emergency events are associated with neonatal HIE, neurological morbidity, and mortality.
- Subjects
CEREBRAL anoxia-ischemia; FETAL monitoring; FETAL heart rate; FETAL distress; OBSTETRICAL emergencies; THERAPEUTIC hypothermia
- Publication
Archives of Gynecology & Obstetrics, 2021, Vol 303, Issue 2, p409
- ISSN
0932-0067
- Publication type
Article
- DOI
10.1007/s00404-020-05757-2