Chandra S, Ramji S, Thirupuram S
Department of Pediatrics, Maulana Azad Medical College, New Delhi.
Indian Pediatr. 1997 Mar;34(3):206-12.
To determine risk factors for perinatal asphyxia.
Cohort study.
Teaching hospital.
All consecutive hospital births were evaluated during the study period. Asphyxia was defined on intrapartum and neonatal resuscitation criteria. Maternal, intrapartum and neonatal variables were recorded in all births. Data was analyzed after stratifying for live and stillbirths by univariate and logistic regression analyses.
Amongst 2371 births (55 fetal deaths and 2316 live births), there were 86 cases of perinatal asphyxia (35 fetal deaths and 51 live births), providing an asphyxia rate of 36.3/1000 births. On multivariate analysis, risk factors significantly associated with asphyxia included prolonged second stage labor (OR 9.4), vaginal breech delivery (OR 6.6), elective cesarean delivery (OR 4.6), pregnancy induced hypertension (PIH) (OR 2.7) and fetal growth retardation (SFD) (OR 2.4). Amongst stillborn, the significant univariate factors associated with asphyxia were prolonged second stage labor (RR 1.7) and cord prolapse (RR 1.7).
There is a need to strengthen intrapartum management and early identification of mothers with PIH or intrauterine growth retardation to reduce asphyxial morbidity and mortality.
确定围产期窒息的危险因素。
队列研究。
教学医院。
在研究期间对所有连续的医院分娩进行评估。根据产时和新生儿复苏标准定义窒息。记录所有分娩的母亲、产时和新生儿变量。通过单因素和逻辑回归分析对活产和死产进行分层后分析数据。
在2371例分娩中（55例死胎和2316例活产），有86例围产期窒息（35例死胎和51例活产），窒息率为36.3/1000例分娩。多因素分析显示，与窒息显著相关的危险因素包括第二产程延长（比值比9.4）、阴道臀位分娩（比值比6.6）、择期剖宫产（比值比4.6）、妊娠高血压综合征（PIH）（比值比2.7）和胎儿生长受限（SFD）（比值比2.4）。在死胎中，与窒息相关的显著单因素是第二产程延长（相对危险度1.7）和脐带脱垂（相对危险度1.7）。
有必要加强产时管理，尽早识别患有PIH或宫内生长受限的母亲，以降低窒息的发病率和死亡率。
