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How often is a low Apgar score the result of substandard care during labour?

Berglund S, Pettersson H, Cnattingius S, Grunewald C - BJOG (2010)

Bottom Line: Main outcome measure Substandard care during labour.Results We found that 62% of cases and 36% of controls were subject to some form of substandard care during labour.The main reasons for substandard care were related to misinterpretation of CTG, not acting on an abnormal CTG in a timely fashion and incautious use of oxytocin.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Science and Education, Karolinska Institutet Södersjukhuset, Stockholm, Sweden.

ABSTRACT
Please cite this paper as: Berglund S, Pettersson H, Cnattingius S, Grunewald C. How often is a low Apgar score the result of substandard care during labour? BJOG 2010;117:968-978. Objective To increase our knowledge of the occurrence of substandard care during labour. Design A population-based case-control study. Setting Stockholm County. Population Infants born in the period 2004-2006 in Stockholm County. Methods Cases and controls were identified from the Swedish Medical Birth Register, had a gestational age of >/=33 complete weeks, had planned for a vaginal delivery, and had a normal cardiotocographic (CTG) recording on admission. We compared 313 infants with an Apgar score of <7 at 5 minutes of age with 313 randomly selected controls with a full Apgar score, matched for year of birth. Main outcome measure Substandard care during labour. Results We found that 62% of cases and 36% of controls were subject to some form of substandard care during labour. In half of the cases and in 12% of the controls, CTG was abnormal for >/=45 minutes before birth. Fetal blood sampling was not performed in 79% of both cases and controls, when indicated. Oxytocin was provided without signs of uterine inertia in 20% of both cases and controls. Uterine contractions were hyperstimulated by oxytocin in 29% of cases and in 9% of controls, and the dose of oxytocin was increased despite abnormal CTG in 19% and 6% of cases and controls, respectively. Assuming that substandard care is a risk factor for low Apgar score, we estimate that up to 42% of the cases could be prevented by avoiding substandard care. Conclusions There was substandard care during labour of two-thirds of infants with a low Apgar score. The main reasons for substandard care were related to misinterpretation of CTG, not acting on an abnormal CTG in a timely fashion and incautious use of oxytocin.

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Apgar score at 5 minutes of age.
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fig01: Apgar score at 5 minutes of age.

Mentions: Of 313 infants with Apgar scores of <7 at 5 minutes of age (Figure 1), 90 (47%) also had an Apgar score of <7 at 10 minutes. Sixty-two cases (20%) were assessed to have HIE, of which 25 infants had HIE I and eight infants had HIE III. Eight of the 313 infants died during the neonatal period.


How often is a low Apgar score the result of substandard care during labour?

Berglund S, Pettersson H, Cnattingius S, Grunewald C - BJOG (2010)

Apgar score at 5 minutes of age.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2901517&req=5

fig01: Apgar score at 5 minutes of age.
Mentions: Of 313 infants with Apgar scores of <7 at 5 minutes of age (Figure 1), 90 (47%) also had an Apgar score of <7 at 10 minutes. Sixty-two cases (20%) were assessed to have HIE, of which 25 infants had HIE I and eight infants had HIE III. Eight of the 313 infants died during the neonatal period.

Bottom Line: Main outcome measure Substandard care during labour.Results We found that 62% of cases and 36% of controls were subject to some form of substandard care during labour.The main reasons for substandard care were related to misinterpretation of CTG, not acting on an abnormal CTG in a timely fashion and incautious use of oxytocin.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Science and Education, Karolinska Institutet Södersjukhuset, Stockholm, Sweden.

ABSTRACT
Please cite this paper as: Berglund S, Pettersson H, Cnattingius S, Grunewald C. How often is a low Apgar score the result of substandard care during labour? BJOG 2010;117:968-978. Objective To increase our knowledge of the occurrence of substandard care during labour. Design A population-based case-control study. Setting Stockholm County. Population Infants born in the period 2004-2006 in Stockholm County. Methods Cases and controls were identified from the Swedish Medical Birth Register, had a gestational age of >/=33 complete weeks, had planned for a vaginal delivery, and had a normal cardiotocographic (CTG) recording on admission. We compared 313 infants with an Apgar score of <7 at 5 minutes of age with 313 randomly selected controls with a full Apgar score, matched for year of birth. Main outcome measure Substandard care during labour. Results We found that 62% of cases and 36% of controls were subject to some form of substandard care during labour. In half of the cases and in 12% of the controls, CTG was abnormal for >/=45 minutes before birth. Fetal blood sampling was not performed in 79% of both cases and controls, when indicated. Oxytocin was provided without signs of uterine inertia in 20% of both cases and controls. Uterine contractions were hyperstimulated by oxytocin in 29% of cases and in 9% of controls, and the dose of oxytocin was increased despite abnormal CTG in 19% and 6% of cases and controls, respectively. Assuming that substandard care is a risk factor for low Apgar score, we estimate that up to 42% of the cases could be prevented by avoiding substandard care. Conclusions There was substandard care during labour of two-thirds of infants with a low Apgar score. The main reasons for substandard care were related to misinterpretation of CTG, not acting on an abnormal CTG in a timely fashion and incautious use of oxytocin.

No MeSH data available.


Related in: MedlinePlus