A risk stratification model to predict adverse neonatal outcome in labor

Objective:the development and evaluation of a labor risk model consisting of a combination of antepartum risk factors and intrapartum fetal heart rate (fhr) characteristics that can reliably identify those infants at risk for adverse neonatal outcome in labor.study design:a nested case–control study of term singleton deliveries at the nine hospitals between march 2007 and december 2009. eligibility criteria included: gestational age ⩾37.0 weeks; singleton pregnancy; documented continuous fhr monitoring for ⩾2 h before delivery; assessment of fhr tracing at least every 20 min; and, available maternal and neonatal outcomes. adverse neonatal outcome was defined as nonanomalous infants admitted to the newborn intensive care unit with either a 5 minute apgar score <7 or an umbilical artery ph<7.1. initial risk score was determined using data available at 1 h after admission. patients with an initial risk score between 7 and 15 were considered high risk. intrapartum risk scores were then created for these patients using fhr tracing data and labor characteristics.result:a total of 51 244 patients were identified meeting study criteria. of the antepartum variables evaluated (n=31), 10 were associated with an adverse outcome. the high-risk group made up 28% of the population and accounted for 59.8% of the adverse outcomes. intrapartum characteristics were then evaluated in this high-risk group. intrapartum evaluation identified the highest risk group with a c/s rate of 40% and adverse outcome rate of 11.3%.conclusion:incorporation of maternal and antepartum risk factors with fhr analysis can improve the ability to identify the fetus at risk in labor.