Severe asphyxia linked to substandard care during labour

April 21, 2010

(PhysOrg.com) -- Asphyxia results from an inadequate supply of oxygen to the fetus during labour and delivery. Although rare, it can lead to perinatal brain injury and perinatal death. Now, a new study from Karolinska Institutet shows that infants of women who received substandard care during labour had a three-fold increased risk of asphyxia at birth.

In the study, which is published in the scientific journal BJOG, researchers from the Department of Clinical Science and Education sought to investigate the impact of substandard care during labour and on infant outcome. The study is based on all births in Stockholm County, Sweden, between 2004 and 2006. The study population represents 24% (74 539) of all births in Sweden during this time. Risk factors and handling of 313 infants with signs of asphyxia at birth (at 5 minutes of age) were compared to 313 healthy control infants.

The researchers found that if there was substandard care during labour, the risk was three-fold that the infant would show signs of asphyxia at 5 minutes of age. The main reasons for substandard care were related to misinterpretation of CTG (recording of fetal heartbeat and uterine contractions during ), not acting on an abnormal CTG in a timely fashion, and misuse of .

While the data relates to deliveries in Sweden, the results emphasize the importance of reacting promptly to signs of asphyxia. The authors call for educational efforts among physicians and midwives to improve CTG interpretation and fetal surveillance.

"There was substandard care during in two thirds of infants born with signs of asphyxia, and in one third of healthy infants", says lead author, Dr Sophie Berglund.

"The main reasons for substandard care are factors that, in theory, are possible to prevent, and in practice, should be possible to reduce through educational efforts and increased awareness of risk factors associated with risk of asphyxia."

More information: Berglund S, Pettersson H, Cnattingius S, Grunewald C. How often is a low Apgar score the result of substandard care during labour?
BJOG; An International Journal of Obstetrics and Gynaecology, 21 April 2010, DOI:10.1111/j.1471-0528.2010.0265.x

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