Maternal demographic and intrapartum antecedents of severe neonatal outcomes at term

Objective: To determine key demographic and intrapartum antecedents predisposing to severe adverse neonatal outcome at term.Methods: This was a retrospective cohort study of severe adverse neonatal outcomes of nonanomalous singleton term births at an Australian tertiary maternity unit between January 2007 and April 2017. Serious neonatal outcome (SNO) was defined as of the following: Apgar score ≤3 at 5 min, severe respiratory distress syndrome, severe acidosis, admission into neonatal intensive care unit (NICU), stillbirth, or neonatal death. Multivariable generalized estimating equations were used to identify key demographic and intrapartum risk factors predisposing to poor neonatal outcomes.Results: There were 77 888 births with SNO occurring in 7247 (9.3%) cases. Young maternal age, raised BMI, indigenous ethnicity, nulliparity, smoking, illicit drug use, and diabetes mellitus were more common in the SANO cohort. Instrumental birth (aOR 3.24, 95%CI 3.02-3.47, p < .001), emergency cesarean section (aOR 1.61, 95%CI 1.49-1.73, p < .001), emergency cesarean for nonreassuring fetal status (aOR 3.45, 95%CI 3.04-3.92, p < .001), cord accidents (aOR 4.98, 95%CI 2.81-8.83, p < .001) and intrapartum hemorrhage (aOR 1.42, 95%CI 1.08-1.87, p = .01) were major antecedents. Induction of labor (aOR 1.08, 95%CI 1.01-1.15, p = .03), prolonged second stage (aOR 1.76, 95%CI 1.55-2.00, p < .001) and use of intramuscular opioids/narcotics (aOR 1.41, 95%CI 1.30-1.52, p < .001) were also associated with adverse neonatal outcome. Low birth weight (< 5th and <10th centiles) and macrosomia (> 90th and >95th centiles) and delivery at 37 weeks and >41 weeks were additional risk factors.Conclusion: There are multiple maternal and intrapartum risk factors which can predispose to severe outcomes in the neonate.