Is perinatal asphyxia predictable?

Area of Science:

• Obstetrics and Gynecology
• Neonatology
• Perinatal Medicine

Background:

• Perinatal asphyxia and hypoxic-ischemic encephalopathy (HIE) pose significant risks to newborns.
• Identifying associated risk factors is crucial for improving maternal and neonatal care.

Purpose of the Study:

• To evaluate the association between perinatal asphyxia/HIE and ante/intrapartum risk factors or abnormal fetal heart rate (FHR) findings.
• To enhance management strategies for mothers and newborns at risk.

Main Methods:

• A prospective observational cohort study was conducted across four hospitals between 2014 and 2016.
• Included neonates (gestational age ≥35 weeks) diagnosed with perinatal asphyxia based on specific criteria (pH ≤7.0, BE ≤-12 mMol/L, Apgar <5, or prolonged resuscitation).
• Pregnancies were categorized by risk (low, antepartum, intrapartum, or both); FHR monitoring followed ACOG guidelines.

Main Results:

• Perinatal asphyxia occurred in 21.5‰, and HIE in 1.1‰ of births.
• Of 281 asphyxiated neonates, 52.3% had antepartum risk, and 43.4% had both ante and intrapartum risk.
• Sentinel events or abnormal FHR preceded 59.8% of asphyxia cases and 81.2% of HIE cases, indicating FHR monitoring limitations.

Conclusions:

• At least one risk factor was identified in all HIE cases and most perinatal asphyxia cases.
• The probability of perinatal asphyxia is extremely low in the absence of identifiable risk factors.
• Fetal heart rate monitoring alone is not a sufficiently reliable tool for predicting perinatal asphyxia.