Low Apgar scores at 5 minutes in a low risk population: maternal and obstetrical factors and postnatal outcome

Revista da Associação Médica Brasileira

Eugenia Maria Assunção Salustiano²  Juliana Alvares Duarte Bonini Campos¹  Silvia Maria Ibidi¹  Rodrigo Ruano¹  Marcelo Zugaib¹ 

[1] ,Universidade de São Paulo Medical School University HospitalSão Paulo SP ,Brazil

关键词: Apgar scores;    term;    asphyxia;    neonatal mortality;    hypoxic-ischemic-encephalopathy;    delivery;    Índice de Apgar;    parto;    asfixia;    mortalidade neonatal;    encefalopatia hipóxico-isquêmica;   

DOI  :  10.1590/S0104-42302012000500017

来源: SciELO

【 摘 要 】

OBJECTIVE: To evaluate the association between Apgar scores of less than seven at five minutes (AS5min < 7) and antenatal factors and postnatal outcomes. METHODS: A retrospective cohort and case-control study of 27,252 consecutive term newborns in a low risk obstetrical population between January 2003 and December 2010. Maternal and infant databases were reviewed from all cases with AS5min < 7 (n = 121; 0.4%) and 363 cases with AS5min > 7 at 5 minutes who were randomly selected by a computer program. The main outcomes were neonatal death, newborn respiratory distress, need for orotracheal intubation and neonatal intensive care unit (NICU), and hypoxic-ischemic-encephalopathy. RESULTS: After multiple regression analysis, repeated late decelerations on cardiotocography (OR: 2.4; 95% CI: 1.4-4.1) and prolonged second stage of labor (OR: 3.3; 95% CI: 1.3-8.3) were associated with AS5min < 7, as well as neonatal respiratory distress (OR: 3.0; 95% CI: 1.3-6.9), orotracheal intubation (OR: 2.5; 95% CI: 1.2-4.8), need for NICU (OR: 9.5; 95% CI: 6.7-16.8), and hypoxic-ischemic-encephalopathy (OR: 14.1; 95% CI: 3.6-54.7). No other antenatal factors were associated with AS5min < 7 (p > 0.05). CONCLUSION: Repeated late decelerations and prolonged second stage of labor in the low-risk population are predictors of AS5min < 7, a situation associated with increased risk of neonatal respiratory distress, need for mechanical ventilatory support and NICU, and hypoxic-ischemic-encephalopathy.

【 授权许可】

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