Comparison of umbilical blood gas and acid-base status of small-for-date and normal Chinese newborns.

A prospective study of umbilical arterial blood gas in appropriate-for-gestational-age (AGA) and small-for-gestational-age (SGA) babies was performed at our hospital from August 1989 to July 1990. A total of of 512 cases were included, 432 cases in the AGA group and 80 cases in the SGA group, with gestational ages ranging from 26 to 42 weeks. Umbilical arterial blood was collected immediately after delivery of the newborns. Comparisons of maternal age, gestational age, birth body weight and body length of infants. Apgar scores at one minute and five minutes, cord arterial blood pH, pO2, pCO2, base excess, bicarbonate, total CO2, O2 saturation and O2 content between the AGA and SGA groups were taken into account. Our results demonstrated significant differences in birth body weight, birth body length, Apgar scores at one minute and five minutes and gestational age in the SGA group compared with those in the AGA group. The parameters of cord arterial blood gas were not correlated with gestational age in either group. The mean pH value in the AGA group (7.30 +/- 0.05) was higher than that in the SGA group (7.28 +/- 0.08). The same trend of difference was also noted between the AGA (7.30 +/- 0.04) and SGA (7.27 +/- 0.07) babies who were delivered by Cesarean section (p < 0.05). The latter results imply a more academic state in SGA babies which is independent of labor. Prepartum asphyxia plays an important role in determining the prognosis of SGA babies. We suggest routine umbilical cord blood gas and acid-base analysis at delivery to assess fetal asphyxia.     

Electronic fetal monitoring in association with paracervical blocks

Three hundred and twenty-six patients in labor were monitored electronically during the administration of paracervical blocks. There were 129 primigravidas and 197 multigravidas in the study. Variable deceleration patterns during labor were observed in 128 patients. Of these, 109 cord problems such as overt and occult prolapse and nuchal entanglement were present. Sixty-five of these babies exhibited an Apgar score of 6 or less at one minute. There were 38 late deceleration patterns, 24 of which had placentas of 400 grams or less. Apgar scores of 6 or less were found in 20 of these infants. One hundred and nineteen infants or 36 per cent had a bradycardia episode after a paracervical block. The low Apgar scores appear to be related to other factors rather than to the paracervical block.     

The very low birthweight infant: incidence and significance of low Apgar scores, "asphyxia," and morbidity. Findings at delivery

Cord blood gas determinations were made on arterial and venous blood from 78 babies weighing less than 2000 gm at birth, including 52 weighing 1500 gm or less. Correlations were made with Apgar scores and intrapartum events as well as with birthweight (BW) and gestational age (GA). Significant differences were seen between mean BW, GA, and Apgar scores for survivors versus nonsurvivors but only BW and GA were found to affect mortality. The incidence of low Apgar scores, which was high, was inversely related to BW and GA. Correlations between cord blood gases and Apgar scores were poor, most newborns showing normal gases irrespective of Apgar scores. The authors conclude that the term "asphyxia" is an overused explanation for low Apgar scores among very low birthweight babies; they believe it should be reserved for those depressed states proved to be associated with disturbed respiratory physiology.     

The Apgar score, acid-base equilibrium of the umbilical cord vessels and early postnatal adaptation in healthy term newborns

The aim of the study is to establish a correlation between Apgar score, acid-base status (ABS) and blood gases (bg) from cord blood and the early postnatal adaptation in healthy term newborns. The study is prospective and includes 52 babies at term born at the State University Hospital Ma?chin Dom, Sofia during a three month period--03-05, 1998 without evidence of asphyxia before and during delivery. All babies are monitored for Apgar score at minute 1 and 5, ABS and bg from umbilical artery (u.a.) and vein (u.v.) examined at birth, as well as capillary ABS and bg 1 hour after birth. Early postnatal adaptation is judged by a neonatologist in the course of two hours. RESULTS: A significant difference is found between all the examined points in the ABS and the blood gases in samples from umbilical artery and vein (p < 0.05), most significantly differ pH, pO2 and O2 Sat (p < 0.001). There is a correlation between 1 minute Apgar score and ABS and bg from umbilical vessels, babies with 1 minute Apgar score 7 having significantly lower pH from u.a. requiring wider range of resuscitation. Babies with 1 minute Apgar score 9/8 and 5 minute Apgar score 10 have definitely less early adaptational problems. CONCLUSION: The use of a combination of evaluation criteria for the condition of the newborn after birth (Apgar score, ABS and bg from cord blood and strict monitoring of early cardio-pulmonary adaptation) guarantees adequate resuscitation in term babies.     

Does the antenatal detection of small-for-gestational-age babies influence their two-year outcomes?

The aim of this paper is to determine whether antenatal detection of small-for-gestational-age (SGA) babies influences 2-year outcomes. All low-birth-weight (<2,500g) infants born in South-EastThames region, England from September 1, 1992 to August 31, 1993 were identified at birth. Antenatal "suspicion" and ultrasound assessment confirming growth restriction was categorized as "detection" of SGA. Postnatally, infants were classified as SGA if they had a birth weight for given gestation below the 10th centile. At 2 years, those below 32 weeks' gestation and a random 25% sample of infants of 32 weeks' gestation or more underwent pediatric assessments. Of 49,787 births, 3,456 (6.9%) were of low birth weight. One thousand four hundred and fifty one (42.5%) were SGA, of whom 611 (42%) were detected antenatally by ultrasound scan. At 2 years, 1,008 (75.8%) of 1,358 expected infants were assessed, 379 (37.6%) were SGA at birth, and 188 (49.6%) were confirmed antenatally. Although undetected infants had higher mean birth weights and gestational ages, they had a higher proportion of perinatal deaths (12.6 vs. 6.4%, RR 1.96: CI 1.32-2.86) than detected infants. At 2 years, detected SGA infants had smaller head circumferences (p = 0.026), a higher prevalence of febrile convulsions (8.0 vs. 3.1 %: p = 0.040) and lower scores on the locomotor (DQA) scale of Griffith's developmental test (p = 0.021) compared with undetected SGA infants. Despite detected SGA fetuses having lower weights and gestation at birth than undetected fetuses, they had significantly lower mortality without a parallel increase in severe 2-year neuro-developmental, clinical, or growth morbidity.     

Could maternal pre-pregnancy body mass index affect Apgar score?

Objective

Obesity is one of global health problems and maternal obesity may be associated with increase in risk of pregnancy complications and neonatal death. The purpose of this study was to evaluate the effect of maternal pre-pregnancy body mass index (BMI) on neonate Apgar score at minute 5.

Methods

In a retrospective cohort study, Apgar score at minute 5 of all singleton term babies of nulliparous women whom were delivered in Shahid Sadoughi Hospital, Yazd, Iran, from 2007 to 2009 were evaluated. Body mass index (BMI: weight in kg/height in m²) of the mothers were calculated and BMI less than 18.5, 18.5–24.9, 25–29.9 and more than 30 were considered underweight, normal, overweight and obesity, respectively. Neonatal Apgar score of 3–7 and less than three was considered as low and very low Apgar score, respectively.

Results

Eighty-eight (2.8 %) women were underweight, 1,401 (44.9 %) normal weight, 1,389 (44.5 %) overweight and 242 (7.8 %) were obese. 477 (15.3 %) and 31(0.7 %) neonates had low and very low Apgar score, respectively at minute 5. Logistic regression analysis showed maternal overweight [in odd ratio of 3.7, 95 % CI 2.4–4.6] and obesity [in odd ratio of 13.4, 95 % CI 9.7–14.1] were risk factors of neonatal low Apgar score, but they had not any statistically significant effect on neonatal very low Apgar score.

Conclusion

Maternal pre-pregnancy overweight should be more concerned to prevent complication of low Apgar score in their newborns.     

Umbilical cord unbound free fatty acid concentration and low apgar score

Increased levels of unbound Free Fatty acid (FFAu) have been found in adults undergoing coronary angioplasty as a result of acute hypoxia-ischemia. We hypohesized that infants suffering from a 1-minute Apgar score of less than 5 will demonstrate elevated FFAu levels in the cord blood. One hundred ninety-nine infants between 25 and 41 weeks gestational age were enrolled in the study. Infants with an Apgar score of less than 5 at 1 minute served as the study group. Blood samples were collected from the umbilical cord and serum FFAu levels were measured with the fluorescent probe acrylodan-derivatized intestinal fatty acid binding protein. The low Apgar score group (n=32, birthweight 3153+/-780 g, gestational age 37.9+/-3.1 weeks) and normal Apgar score group (n=167, birthweight 3067+/-847 g, gestational age 37.5+/-3.5 weeks) were significantly different with respect to Apgar score at 1 minute (3.0+/-1.2 versus 8.4+/-1.1), Apgar score at 5 minutes (6.9+/-versus 8.9+/-0.5), cord pH (7.16+/-0.12 versus 7.28+/-0.07), and in the frequency of meconium passage (40.6% versus 14.9%). Cord FFAu levels were 4.4+/-1.7 versus 3.2+/-1.2 nM (p<0.001), respectively. Cord FFAu correlated inversely with Apgar score at 1 minute (r=-0.31, p<0.05) and with cord pH (r=-0.12, p<0.05), but not with birthweight or gestational age. In infants with low 1-minute Apgar scores, cord free fatty acid levels were significantly elevated compared with those from controls.     

Outcome after successful resuscitation of babies born with apgar scores of 0 at both 1 and 5 minutes

OBJECTIVE: Our purpose was to evaluate the outcome of infants who underwent successful resuscitation after initial Apgar scores of 0 at both 1 and 5 minutes.Study Design: Eligible infants were identified through the perinatal database at the University of Tennessee, Memphis. Hospital records and long-term outcomes, where available, of babies who met the above criteria occurring between January 1986 and February 1999 were reviewed. RESULTS: Thirty-three of 81,603 infants (0.4/1000 births) met our study criteria. Twenty-two (67%) babies died during hospitalization. Mortality decreased significantly from 100% for babies with a birth weight of <750 g to 38% for those weighing > or =2500 g at birth (P =.03). All 6 babies delivered before 26 weeks' gestation died. The incidence of 10-minute Apgar scores >0 was significantly higher among survivors than among those who subsequently died (82% vs 33%, P <.05). Nine survivors had hypoxic-ischemic encephalopathy diagnosed before discharge. Of the 7 infants with available follow-up, 4 had significant persisting morbidity. Two infants had normal neurologic examinations at follow-up. CONCLUSION: Survival in babies born with 1- and 5-minute Apgar scores of 0 is predicted by birth weight, gestational age, and 10-minute Apgar score. Long-term sequelae are common but not ensured.     

Acidosis in newborns with nuchal cords and normal Apgar scores.

OBJECTIVE: Apgar scores and cord blood gases (BG) and pH were compared between a group of babies with nuchal cords and a group without nuchal cords and uncomplicated deliveries. STUDY DESIGN: We collected umbilical arterial (UA) and umbilical venous (UV) blood samples from the placentas of term infants from both normal deliveries (NORM, n=29) and nuchal cords (NUCH, n=33). BG/pH and hematocrit were measured; base deficits and oxygen contents were calculated; and a member of the study assigned Apgar scores and demographic data were collected from the babies' charts. RESULTS: Median Apgar scores in the NUCH babies at 1 and 5 minutes were 9 and 9 respectively, which did not differ from the NORM infants. The pH, PCO(2), and oxygen content obtained from UV of the NUCH infants was not statistically different from the NORM. The pH and oxygen content of the NUCH UA was significantly lower than that of the NORM. The UA PCO(2) in the NUCH was greater than the NORM. Veno-arterial (VA) differences (Delta VA) in pH and PCO(2) of the NUCH infants were greater than that of the NORM. CONCLUSION: The Apgar score is not a sensitive indicator of acid-base changes in nuchal cord patients; UV samples alone may be misleading. UA must be sampled to detect the hypercapnia and diminished oxygen content that is a result of the nuchal cord.     

Plasma volume, umbilical artery Doppler flow, and antepartum fetal heart testing in high-risk pregnancies

The purpose of this clinical study is to investigate the diagnostic value of plasma volume (PV), nonstress test (NST), contraction stress test (CST), and umbilical artery Doppler (UAD) in detecting fetal compromise in 81 patients (83 fetuses) at risk for fetal growth retardation. Neither PV nor UAD studies were used in the clinical management. There were two stillbirths and three neonatal deaths for a perinatal mortality of 6%. Twenty-seven infants (32.5%) were small for gestational age (SGA), seven (8.6%) had cord pH 7.20 or less, and five (6.2%) had 5-minute Apgar scores less than 7. Overall, PV had the highest sensitivity and NST the highest specificity regarding delivery of SGA infants. The positive and negative predictive values for infants with low cord pH and low Apgar scores were similar among the various tests. There were nine fetuses with zero or reverse diastolic flow: seven were SGA (four perinatal deaths) and all of them had both nonreactive NST and positive CST. The other two infants were appropriate for gestational age with all other tests being normal. Antepartum fetal heart rate testing appears to be similar to other tests in predicting poor fetal outcome in high-risk pregnancies.     

ROUTINE PROPHYLACTIC EPISIOTOMY: Is It Always Necessary?

Routine prophylactic performance of episiotomy has not been scientifically evaluated since it was first suggested in 1918. This is a retrospective report of 100 uncomplicated spontaneous vaginal term births in which prophylactic episiotomy was not performed. All of the infants had an Apgar score of 9 or 10 at five minutes, and 97 had an Apgar score of 9 at one minute. Two babies had an Apgar score of 7 at one minute, and one had an Apgar score of 4 at one minute. All were in excellent health at their two-and six-week pediatric examinations. Sixty-seven of the women sustained no lacerations, 16 had first degree lacerations that did not require repair, and six had first degree lacerations that required sutures. Eleven women sustained second degree lacerations. There were no third or fourth degree lacerations. In the absence of maternal or fetal complications routine prophylactic episiotomy appears to be unnecessary.     

Smoking during pregnancy: risk for intrauterine growth retardation and persisting microsomia

Smoking during pregnancy is a major risk factor for intrauterine growth retardation. The aim of the Thuringian SGA - (small-for-gestational-age) - study was to evaluate the effects of maternal smoking during pregnancy on birth weight and length as well as postnatal growth dynamics and catch-up growth.Between 1992 and 2002 in all 2 447 liveborn children were assessed with birth weight (GG) <10th percentile and/or birth length (GL) <- 2.0 SDS. A questionnaire was sent to 383 parents of severe SGA children (GG and/or GL <- 2.5 SDS) to report weight and height of the children actually. 108 reports could analysed (mean age 8.0±3.4 years of life).The number of SGA babies in regard to all liveborn children decreased from 14.1% to 9.4% between 1992 and 2002. 14% of SGA babies were born preterm. The mean nicotine abuse was 2 cigarettes per day (range 0-40). 17.6% of the mothers of SGA babies were smoking, whereas in severe SGA 26.9% of smokers was recorded. There is a inverse correlation of nicotine abuse with birth weight (r=- 0.09; p<0.01) or birth length (r=- 0.08; p<0.01). Catch-up growth did not exist in 30.6% of the severe growth restricted children. The risk for short stature in later life was doubled in SGA children.Nicotine abuse during pregnancy is a risk factor for an SGA baby and could have long-lasting effects on growth dynamics during childhood with a lack of catch-up growth.     

Correlation of neonatal acid-base status with Apgar scores and fetal heart rate tracings

In this study the immediate neonatal acid-base status, obtained via a double-clamped segment of umbilical cord, in 75 term, singleton vaginal deliveries was compared to electronic fetal heart rate recordings and Apgar scores. Of 75 neonates, 59 had 1-minute Apgar scores greater than or equal to 7 and 52 had an initial pH greater than 7.20. Six of the 16 neonates with a 1-minute Apgar score less than 7 demonstrated a low pH (less than 7.20). At 5 minutes only eight of 75 neonates had Apgar scores less than 7 with six of the eight having pH values less than 7.20. Of those neonates with Apgar scores greater than or equal to 7 and pH less than 7.20 (seven neonates at 1 minute, two at 5 minutes), none had metabolic acidosis. Eighteen fetal heart rate tracings were considered abnormal; acidosis was confirmed in eight (44%) by pH criteria, yet only three of the eight neonates had low Apgar scores. Our investigations suggest that the combination of fetal heart rate monitoring, cord blood pH, and Apgar assessment is better than any one parameter alone as an evaluation of fetal status just after delivery.     

Conservative management in breech deliveries leads to similar results compared with cephalic deliveries.

OBJECTIVE: To compare the difference in neonatal mortality and morbidity between breech and cephalic presentations at term. METHODS: This was a retrospective matched cohort study in two centers between July 1998 and April 2000, including all breech deliveries between 37(+0) and 41(+6) weeks, except cases with multiple gestations and antepartum intrauterine deaths. All breech presentations were matched with two cephalic presentations. Onset of labor and route of delivery were recorded, and neonatal data were categorized into variables belonging to serious morbidity or moderate morbidity. RESULTS: One thousand one hundred and nineteen deliveries were included. Three hundred and seventy-three babies were in breech position and 746 in cephalic position. The gestational age and birth weight of the babies in the breech group were lower than in the cephalic group (p < 0.001). Congenital abnormalities occurred more often in the breech group (p < 0.005). An elective cesarean section was performed in 23.3% of breech presentations versus 3.5% of cephalic presentations (p < 0.001). Emergency cesarean sections were done in 29.2% of breech presentations versus 8.8% of cephalic presentations (p < 0.001). Children born in breech presentation had lower Apgar scores after 1 minute (p < 0.0001), but 5-minute Apgar scores were the same in both groups (p = 0.22). Children born in breech presentation received significantly more resuscitation than children born in cephalic presentation (p < 0.001). In both groups no perinatal mortality occurred. No differences were observed in percentages of children with serious or moderate neonatal morbidity between the breech and cephalic lies. CONCLUSIONS: Although the numbers are small, this study shows that the conservative (vaginal) approach in selected fetuses in breech position can be safely pursued with neonatal results similar to fetuses in cephalic presentation.     

Evaluation of midwife-led care provided at the Royal Bournemouth Hospital

OBJECTIVE: To compare the outcome of care given to women 'booking' for delivery in a midwife-led maternity unit with that for comparable women 'booking' for care in a consultant obstetric unit. DESIGN AND METHOD: Prospective cohort study with a quasi-experimental design and data extracted from case notes. SETTING: East Dorset, midwife-led maternity unit at Royal Bournemouth Hospital and consultant-led maternity unit at Poole General Hospital. SUBJECTS: Two cohorts of women who satisfied the criteria for 'booking' at the Royal Bournemouth Hospital. Of these 794 'booked' at Bournemouth from 1 November 1992 to 30 June 1993 and 705 'booked' at Poole over the same period. MAIN PROCESS AND OUTCOME MEASURES: Care given, morbidity in women and their babies, transfers during the antenatal period and in labour. FINDINGS: Of the women who initially 'booked' for Bournemouth, 62.3% actually delivered there, 27.1% transferred before labour and a further 9.2% transferred during labour. No differences were seen between those 'booked' for Bournemouth or Poole in the proportions of low birthweight babies, babies who were transferred to special care or babies who had congenital abnormality. Higher proportions of babies whose mothers 'booked' for delivery in Poole were resuscitated and had one minute Apgar scores below seven but there was no difference in the five minute scores. Similar proportions of women had perineal tears but fewer of the women 'booked' for delivery in Bournemouth had an episiotomy. 'Booking' for Poole was associated with higher rates of induction and augmentation of labour and greater use of anesthesia. 'Booking' for Bournemouth was associated with a shorter first stage and a longer third stage of labour. Women 'booked' for delivery in Bournemouth were no more likely to be delivered by a midwife than those 'booked' for Poole. CONCLUSIONS: There was very little difference between the groups of women who initially 'booked' for delivery at the two units. There were differences in the patterns of care received, but no major differences in the outcome for the women or their babies were detected.     

The relationship between the five minute Apgar score,mode of birth and neonatal outcomes

Objective: To investigate the relationship between the five-minute Apgar score categories (low, intermediate, and normal), mode of birth and neonatal outcomes.

Methods: This was a retrospective cross sectional study of term singleton deliveries at Mater Mothers’ Hospital in Brisbane, Australia between January 2007 and December 2015. The five minute score was subdivided in to three categories – low (0–3), intermediate (4–6), and normal (≥7). These were correlated with adverse neonatal outcomes and mode of birth. The referent cohort was the normal Apgar group.

Results: The study cohort consisted of 39,258 births with a recorded five minute Apgar score. Of these, 38,705 (98.6%) neonates had a normal (≥7) Apgar score, 439 (1.1%) had an intermediate score (4–6) and 114 (0.3%) had a low (0–3) score. Neonatal complications including respiratory distress, feeding problems, hypothermia, and seizures were all significantly associated with both low and intermediate Apgar scores. Emergency operative birth (caesarean and instrumental) conveyed a higher risk of low and intermediate scores and poorer neonatal outcomes.

Conclusions: Low and intermediate five minute Apgar scores were strongly associated with mode of birth and poorer neonatal outcomes.     

Intrauterine resuscitation with tocolysis. An alternate month clinical trial

Fifty patients were compared for the purpose of investigating the usefulness of intrauterine resuscitation with tocolysis (IURT). Terbutaline was given, as an intravenous bolus, to 31 women in labor in whom fetal distress was diagnosed and urgent delivery by cesarean section was indicated. In alternate months, a control group of 19 women with similar diagnoses was urgently delivered after standard interventions such as maternal positioning, oxygen administration, hydration, and discontinuation of oxytocin. Improvement in perinatal outcome was shown in infants after IURT. Apgar scores were less than 7 in 42% of the study group and in 71% of the control group at 1 minute (P = .04). Five-minute Apgar scores less than 7 occurred in 7% of the study group and 24% of the control group. A low venous pH was seen in 55% of the control group compared with 29% of the infants resuscitated with terbutaline. Estimated maternal blood loss and hematocrit change was not different in the two groups. Maternal blood pressure and pulse changes following IURT were modest and of doubtful significance. We conclude that intravenous terbutaline administered as a bolus injection at the time of fetal distress in labor improves infant outcome as evidenced by more vigorous Apgar scores and less acidemia without significant adverse physiologic effects on the mother.     

Increased maternal serum human chorionic gonadotropin concentrations are an independent risk factor for SGA in dichorionic twin gestations.

OBJECTIVE: To determine maternal and neonatal complications among dichorionic and monochorionic twins with isolated midtrimester elevated maternal serum human chorionic gonadotropin (MShCG). MATERIAL AND METHODS: MShCG was determined in 247 women with dichorionic twins and 32 women with monochorionic twins between 16-18 weeks gestation. Among the dichorionic twins 219 patients had MShCG < 2.5 MoM, 14 between 2.5-3.0 MoM and 14 above 3.0 MoM. Of the patients with monochorionic twins 15 had MShCG < 2.5 MoM, nine between 2.5-3.0 MoM and 8 above 3.0 MoM. All patients had maternal serum alpha fetoprotein < 2.5 MoM. Karyotype was normal among all neonates. Statistical analysis was performed with SPSS package. RESULTS: Patients with monochorionic twins had higher rates of cesarean section when MShCG was > 3.0 MoM (100% vs. 44%; p = 0.03) and of preterm delivery when MShCG was > 2.5 MoM (87.5% vs. 46.7%; p = 0.04). A non significant higher rate of small for gestational age (SGA) neonates was found when MShCG was > 2.5 MoM among first twin (37.5% vs. 13.3%; p = 0.08). In contrast, patients with dichorionic twins had higher rates of SGA neonates and low 1 minute Apgar scores in the second twin when MShCG was > 2.5 MoM (23.1% vs. 10%; p = 0.04, 15.4% vs. 11.9%; p < 0.01). A multivariate logistic regression model with forward stepwise selection was performed with SGA as outcome variable. The model included the following variables: MShCG, hypertensive disorders, gestational age at delivery, chorionicity, twin order, cesarean section (CS) and preterm delivery. MShCG levels were the only significant factor predicting SGA among bichorionic twins (OR 1.76, 95% CI 1.2-2.5). CONCLUSIONS: (1) Increased concentrations of MShCG are an independent risk factor for SGA among dichorionic twins. (2) MShCG > 2.5 MoM are associated with adverse maternal outcome among monochorionic twins.     

Antenatal and Intrapartum Events Influencing Outcome in Very Low Birth-Weight Infants

The influence of antenatal and intrapartum events and the route of delivery on Apgar scores and short-term outcome was studied in 359 singleton very low birth-weight infants who were resuscitated adequately at birth and had no lethal congenital anomalies. When stratified according to gestation the occurrence of antepartum haemorrhage, pregnancy-induced hypertension and amnionitis had no influence on the outcome while cord prolapse in infants less than 26 weeks resulted in 100% mortality. Prolonged rupture of membranes significantly improved the chances of their survival. The route of delivery did not influence survival, but greater numbers of babies between 27 and 30 weeks delivered by the breech had lower Apgar scores both at 1 and 5 minutes. Survival was dependent on gestational age and the condition at birth among this group of very low birth-weight infants.     

A weighted risk index for antenatal prediction of perinatal outcome

OBJECTIVE: The hypothesis is that a risk score derived from the risk index (RI) is correlated with perinatal outcomes. STUDY DESIGN: The RI is a weighted numerical score based on gestational risk factors applied to 782 gravidas antepartum. Management was independent of the score. Birth weight, Apgar scores, and cesarean birth were correlated with risk score. RESULTS: The break point score in this non-Gaussian cohort was 6. Using 6, 80.2% were low and 19.8% high risk. Birth weight < 2500 gm was inversely correlated (p < .001) and occurred in 13% of the high risk ((3)6) and 4.9% of the low risk (< 6) group, relative risk (RR) 2.7. C-section correlated (p < .001), and occurred in 51% of the high and 23% of the low risk group, RR 2.4. risk score inversely correlated with 5 minute Apgar (RR 4.7 p < .002) but not the 1 minute Apgar score. CONCLUSION: The RI identified gravidas at risk for low birth weight, low 5 minute Apgar score, and cesarean birth.