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  • Title: Perinatal asphyxia: multivariate analysis of risk factors in hospital births.
    Author: Chandra S, Ramji S, Thirupuram S.
    Journal: Indian Pediatr; 1997 Mar; 34(3):206-12. PubMed ID: 9282487.
    Abstract:
    OBJECTIVE: To determine risk factors for perinatal asphyxia. DESIGN: Cohort study. SETTING: Teaching hospital. METHODS: All consecutive hospital births were evaluated during the study period. Asphyxia was defined on intrapartum and neonatal resuscitation criteria. Maternal, intrapartum and neonatal variables were recorded in all births. Data was analyzed after stratifying for live and stillbirths by univariate and logistic regression analyses. RESULTS: Amongst 2371 births (55 fetal deaths and 2316 live births), there were 86 cases of perinatal asphyxia (35 fetal deaths and 51 live births), providing an asphyxia rate of 36.3/1000 births. On multivariate analysis, risk factors significantly associated with asphyxia included prolonged second stage labor (OR 9.4), vaginal breech delivery (OR 6.6), elective cesarean delivery (OR 4.6), pregnancy induced hypertension (PIH) (OR 2.7) and fetal growth retardation (SFD) (OR 2.4). Amongst stillborn, the significant univariate factors associated with asphyxia were prolonged second stage labor (RR 1.7) and cord prolapse (RR 1.7). CONCLUSIONS: There is a need to strengthen intrapartum management and early identification of mothers with PIH or intrauterine growth retardation to reduce asphyxial morbidity and mortality. The risk factors for perinatal asphyxia were investigated in a cohort study of all 2371 deliveries at Maulana Azad Medical College in New Delhi, India, in the study period. There were 86 cases of asphyxia (35 fetal deaths and 51 live births), for an overall asphyxia rate of 36.3/1000 births. Asphyxia prevalence was 2.2% among live births compared with 63.6% among still births. Multivariate analysis identified the following significant risk factors for asphyxia: prolonged second stage labor (odds ratio (OR), 9.4), vaginal breech delivery (OR, 6.6), elective Cesarean delivery (OR, 4.6), pregnancy-induced hypertension (OR, 2.7), and fetal growth retardation (OR, 2.4). These findings indicate that most perinatal asphyxia is associated with pregnancy-related complications such as hypertension and preventable intrapartum problems. Decreases in the incidence of perinatal asphyxia require the identification of pregnant women at risk for institutional delivery and training of medical personnel to manage complicated labor and delivery.
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