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Outcome in low risk pregnancies

R Arya1, T Pethen, R B Johanson

  • 1Department of Paediatrics, North Staffordshire Hospital and University of Keele Stoke on Trent.

Archives of Disease in Childhood. Fetal and Neonatal Edition
|September 1, 1996
PubMed
Summary

Even in low-risk pregnancies suitable for home birth, about 5% require hospital transfer. Midwives need advanced resuscitation skills, as neonatal resuscitation needs are higher than previously estimated.

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Area of Science:

  • Obstetrics and Gynecology
  • Neonatal Care
  • Public Health

Background:

  • Home birth is considered for low-risk pregnancies.
  • Assessing the safety and resource needs for home births requires understanding in-hospital outcomes for similar low-risk groups.
  • Previous estimates of neonatal resuscitation needs may be underestimated.

Purpose of the Study:

  • To evaluate obstetric and neonatal outcomes in a hospital-based cohort of very low-risk pregnancies.
  • To determine the suitability of these outcomes for home delivery scenarios.
  • To inform guidelines for home birth safety and midwife training.

Main Methods:

  • Retrospective analysis of 32,424 deliveries at North Staffordshire Maternity Hospital (July 1988 - August 1993).
  • Identification of a low-risk subgroup (1,314 deliveries, 4% of total).
  • Analysis of delivery mode, neonatal interventions, and neonatal unit admissions within the low-risk group.

Main Results:

  • 5.1% of low-risk women had operative deliveries (2.4% Caesarean section).
  • Neonatal resuscitation was required for 23.9% of babies, with 5.1% needing assisted ventilation and 0.4% intubation.
  • 14 babies (1.1%) were admitted to the neonatal unit, and one died.

Conclusions:

  • Approximately 5% of women with low-risk pregnancies require transfer during labor.
  • Midwives attending home births must be proficient in neonatal resuscitation, particularly bag and mask techniques.
  • The actual need for neonatal resuscitation in low-risk deliveries appears higher than the 0.2% suggested by prior reports.

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