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A risk stratification model to predict adverse neonatal outcome in labor

Journal of Perinatology volume 33, pages 914–918 (2013)Cite this article

Subjects

Abstract

Objective:

The development and evaluation of a labor risk model consisting of a combination of antepartum risk factors and intrapartum fetal heart rate (FHR) characteristics that can reliably identify those infants at risk for adverse neonatal outcome in labor.

Study design:

A nested case–control study of term singleton deliveries at the nine hospitals between March 2007 and December 2009. Eligibility criteria included: gestational age ⩾37.0 weeks; singleton pregnancy; documented continuous FHR monitoring for ⩾2 h before delivery; assessment of FHR tracing at least every 20 min; and, available maternal and neonatal outcomes. Adverse neonatal outcome was defined as nonanomalous infants admitted to the newborn intensive care unit with either a 5 minute Apgar score <7 or an umbilical artery pH<7.1. Initial risk score was determined using data available at 1 h after admission. Patients with an initial risk score between 7 and 15 were considered high risk. Intrapartum risk scores were then created for these patients using FHR tracing data and labor characteristics.

Result:

A total of 51 244 patients were identified meeting study criteria. Of the antepartum variables evaluated (n=31), 10 were associated with an adverse outcome. The high-risk group made up 28% of the population and accounted for 59.8% of the adverse outcomes. Intrapartum characteristics were then evaluated in this high-risk group. Intrapartum evaluation identified the highest risk group with a C/S rate of 40% and adverse outcome rate of 11.3%.

Conclusion:

Incorporation of maternal and antepartum risk factors with FHR analysis can improve the ability to identify the fetus at risk in labor.

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Acknowledgements

This study was supported by grants funded by Deseret Foundation, Salt Lake City, UT, USA, grant 576.

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Authors and Affiliations

  1. Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT, USA

    C M Holmgren, M S Esplin, M Jackson, T F Porter & M W Varner

  2. Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA

    C M Holmgren, M S Esplin, M Jackson, T F Porter & M W Varner

  3. Department of Obstetrics and Gynecology, Women and Newborn Clinical Programs, Intermountain Healthcare, Salt Lake City, UT, USA

    E Henry

  4. Department of Cardiology, Intermountain Heart Institute, Intermountain Healthcare, Salt Lake City, UT, USA

    B D Horne

  5. Division of Genetic Epidemiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA

    B D Horne

Authors
  1. C M Holmgren
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  2. M S Esplin
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  3. M Jackson
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  4. T F Porter
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  5. E Henry
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  6. B D Horne
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  7. M W Varner
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Corresponding author

Correspondence to C M Holmgren.

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Competing interests

The authors declare no conflict of interest.

Additional information

This study was presented at the 31st Annual Meeting of the Society for Maternal-Fetal Medicine, San Francisco, CA, USA, February 2011.

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Holmgren, C., Esplin, M., Jackson, M. et al. A risk stratification model to predict adverse neonatal outcome in labor. J Perinatol 33, 914–918 (2013). https://doi.org/10.1038/jp.2013.64

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