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).

Conclusion: 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.

• Apgar score
• birth asphyxia
• fetal distress
• obstetric interventions
• perinatal mortality
• trends

Acknowledgements

The authors would like to thank all the Dutch midwives, obstetricians, neonatologists and other perinatal healthcare provides for the registration of perinatal information. We would also like to thank the Foundation of the Netherlands Perinatal Registry (www.perinatreg.nl) for permission to use the registry data. This work was presented as a poster presentation at the SMFM 33rd Annual Meeting on 15 February 2013 in San Francisco, CA, USA.

Declaration of interest

The authors declare that they have no conflict of interest.