Risk factors for asphyxia associated with substandard care during labor.
OBJECTIVE
To identify maternal, pregnancy, delivery and infants characteristics related to neonatal asphyxia and associated with substandard care.


METHODS
A nation-wide case-control study in Sweden.


METHODS
Infants born between 1990 and 2005 with a gestational age > or = 33 weeks and a spontaneous or induced onset of labor.


METHODS
Cases were 177 previously identified infants suffering from encephalopathy caused by asphyxia where there was suspected substandard care during labor, and where claims for financial compensation were filed. Controls were identified from the population-based Swedish Medical Birth Register, had an Apgar score of 10 at five minutes, and were alive at 28 days of age.


METHODS
Severe asphyxia associated with substandard care during childbirth.


RESULTS
Maternal and delivery factors associated with asphyxia included maternal age > or = 30 years, short maternal stature (< or =159 cm), previous cesarean delivery, insulin-dependent diabetes before pregnancy and gestational diabetes, induced deliveries and delivery at night, with adjusted odds ratios (ORs) ranging from a two- to fourfold increase in risk. Compared with non-dystocic deliveries, the OR for dystocic deliveries was fivefold higher, and was further increased if epidural anesthesia or opioids were used. Small- and large-for-gestational age infants, post-term (> or =42 weeks) births, twins and breech deliveries had a three- to eightfold increase in risk of asphyxia when there was substandard care during labor.


CONCLUSIONS
Dystocia of labor, especially if epidurals and/or opioids are used, is the strongest risk factor associated with substandard care causing severe asphyxia during labor.
Berglund
Sophie
S
Institution for Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. Sophie.berglund@sodersjukhuset.se
Grunewald
Charlotta
C
Pettersson
Hans
H
Cnattingius
Sven
S
D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000453:epidemiology*; D015148:Cardiotocography; D016022:Case-Control Studies; D002983:Clinical Competence; D004420:Dystocia / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011787:Quality of Health Care; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology