title: Trends in birth asphyxia, obstetric interventions and perinatal mortality among term singletons: a nationwide cohort study.
abstract: OBJECTIVE
  The objective of the present study is to investigate trends in birth asphyxia and perinatal mortality in the Netherlands over the last decade.
  
  
  METHODS
  A nationwide cohort study among women with a term singleton pregnancy. We assessed trends in birth asphyxia in relation to obstetric interventions for fetal distress. Birth asphyxia was defined as a 5-minute Apgar score < 7 (any asphyxia) or 5-minute Apgar score < 4 (severe asphyxia). Perinatal mortality was defined as mortality during delivery or within 7 days after birth. Multivariable analyses were used to adjust for confounding factors.
  
  
  RESULTS
  The prevalence of birth asphyxia was 0.85% and severe asphyxia 0.16%. Between 1999 and 2010 birth asphyxia decreased significantly with approximately 6% (p = 0.03) and severe asphyxia with 11% (p = 0.03). There was no significant change in perinatal mortality rate (0.98 per 1000 live births). Simultaneously the referral rate from primary to secondary care during labor increased from 20% to 24% (p < 0.0001) and the intervention rate for fetal distress from 5.9% to 7.7% (p < 0.0001).
  
  
  CONCLUSIONS
  In the Netherlands, the risk of birth asphyxia among term singletons has slightly decreased over the last decade; without a significant change in perinatal mortality.
authors.affiliation: Department of Obstetrics and Gynaecology and.
authors.forename: Sabine
authors.initials: S
authors.lastname: Ensing
authors.forename: Ameen
authors.initials: A
authors.lastname: Abu-Hanna
authors.forename: Jelle M
authors.initials: JM
authors.lastname: Schaaf
authors.forename: Ben Willem J
authors.initials: BW
authors.lastname: Mol
authors.forename: Anita C J
authors.initials: AC
authors.lastname: Ravelli
mesh_terms: D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000453:epidemiology*; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D005316:Fetal Distress / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000628:therapy; D054238:Perinatal Mortality / Q000639:trends*; D011247:Pregnancy; D012042:Registries; D047929:Term Birth
keywords: Apgar score; birth asphyxia; fetal distress; obstetric interventions; perinatal mortality; trends