Maternal hemoglobin level and its relation to fetal distress, mode of delivery, and short-term neonatal outcome: a retrospective cohort study

Lauren Maria Bullens (Corresponding author), Julia Sandra Smith, Sophie Eva Marieke Truijens, Marieke Beatrijs van der Hout-van der Jagt, Pieter Jurjen van Runnard Heimel, Swan Gie Oei

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Abstract

AIM: We aimed to investigate if the risk of fetal distress during term labor is related to the intrapartum maternal hemoglobin (Hb) level. Second, we investigated the relation between mode of delivery, reason for instrumental delivery and short-term neonatal outcome and maternal Hb. Third, we aimed to identify factors influencing intrapartum maternal Hb level.

METHODS: A retrospective cohort study was performed in a tertiary hospital in The Netherlands, including data from women who gave birth between 2009 and 2016. To determine whether the likelihood of fetal distress to occur was dependent on intrapartum Hb, multivariate regression models were run with intrapartum Hb as the main independent variable of interest. Hb was used as a continuous value. We repeated this procedure for the likelihood of instrumental vaginal delivery (IVD), cesarean section (CS), 5-min Apgar score < 7, and umbilical cord arterial pH ≤ 7.05 to occur. Also, we identified factors influencing intrapartum Hb level using linear regression analysis.

RESULTS: Data of 9144 patients were analyzed. Intrapartum Hb did not contribute to the prediction of the likelihood of fetal distress, IVD for nonprogressive labor, CS for fetal condition, 5-min Apgar score < 7, and pHa ≤ 7.05. However, there was a unique statistically significant contribution of Hb to the prediction of the likelihood of IVD for any reason and IVD for fetal distress and CS for any reason and CS for nonprogressive labor. IVD for fetal distress was related to a higher intrapartum Hb level, whereas CS for nonprogressive labor was related to a lower intrapartum Hb level. Intrapartum Hb level was influenced by maternal age, ethnicity, parity, fetal sex, and birth weight.

CONCLUSIONS: The risk of fetal distress and adverse neonatal outcome is not related to intrapartum Hb levels. However, our data suggest that mode of delivery is dependent on intrapartum Hb, as shown in a large tertiary population. We recommend further investigating this relation in a large prospective study.

Original languageEnglish
Number of pages7
JournalJournal of Maternal-Fetal and Neonatal Medicine
DOIs
Publication statusE-pub ahead of print - 31 Jan 2019

Fingerprint

Fetal Distress
Hemoglobins
Cohort Studies
Retrospective Studies
Mothers
Cesarean Section
Apgar Score
Fetal Weight
Umbilical Cord
Maternal Age
Parity
Tertiary Care Centers
Birth Weight
Netherlands

Keywords

  • Fetal distress
  • instrumental delivery
  • maternal hemoglobin
  • neonatal outcome
  • obstetric labor

Cite this

@article{1705e274081c4e7b81c97ab88df2531c,
title = "Maternal hemoglobin level and its relation to fetal distress, mode of delivery, and short-term neonatal outcome: a retrospective cohort study",
abstract = "AIM: We aimed to investigate if the risk of fetal distress during term labor is related to the intrapartum maternal hemoglobin (Hb) level. Second, we investigated the relation between mode of delivery, reason for instrumental delivery and short-term neonatal outcome and maternal Hb. Third, we aimed to identify factors influencing intrapartum maternal Hb level.METHODS: A retrospective cohort study was performed in a tertiary hospital in The Netherlands, including data from women who gave birth between 2009 and 2016. To determine whether the likelihood of fetal distress to occur was dependent on intrapartum Hb, multivariate regression models were run with intrapartum Hb as the main independent variable of interest. Hb was used as a continuous value. We repeated this procedure for the likelihood of instrumental vaginal delivery (IVD), cesarean section (CS), 5-min Apgar score < 7, and umbilical cord arterial pH ≤ 7.05 to occur. Also, we identified factors influencing intrapartum Hb level using linear regression analysis.RESULTS: Data of 9144 patients were analyzed. Intrapartum Hb did not contribute to the prediction of the likelihood of fetal distress, IVD for nonprogressive labor, CS for fetal condition, 5-min Apgar score < 7, and pHa ≤ 7.05. However, there was a unique statistically significant contribution of Hb to the prediction of the likelihood of IVD for any reason and IVD for fetal distress and CS for any reason and CS for nonprogressive labor. IVD for fetal distress was related to a higher intrapartum Hb level, whereas CS for nonprogressive labor was related to a lower intrapartum Hb level. Intrapartum Hb level was influenced by maternal age, ethnicity, parity, fetal sex, and birth weight.CONCLUSIONS: The risk of fetal distress and adverse neonatal outcome is not related to intrapartum Hb levels. However, our data suggest that mode of delivery is dependent on intrapartum Hb, as shown in a large tertiary population. We recommend further investigating this relation in a large prospective study.",
keywords = "Fetal distress, instrumental delivery, maternal hemoglobin, neonatal outcome, obstetric labor",
author = "Bullens, {Lauren Maria} and Smith, {Julia Sandra} and Truijens, {Sophie Eva Marieke} and {van der Hout-van der Jagt}, {Marieke Beatrijs} and {van Runnard Heimel}, {Pieter Jurjen} and Oei, {Swan Gie}",
year = "2019",
month = "1",
day = "31",
doi = "10.1080/14767058.2019.1573221",
language = "English",
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Maternal hemoglobin level and its relation to fetal distress, mode of delivery, and short-term neonatal outcome : a retrospective cohort study. / Bullens, Lauren Maria (Corresponding author); Smith, Julia Sandra; Truijens, Sophie Eva Marieke; van der Hout-van der Jagt, Marieke Beatrijs; van Runnard Heimel, Pieter Jurjen; Oei, Swan Gie.

In: Journal of Maternal-Fetal and Neonatal Medicine, 31.01.2019.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Maternal hemoglobin level and its relation to fetal distress, mode of delivery, and short-term neonatal outcome

T2 - a retrospective cohort study

AU - Bullens, Lauren Maria

AU - Smith, Julia Sandra

AU - Truijens, Sophie Eva Marieke

AU - van der Hout-van der Jagt, Marieke Beatrijs

AU - van Runnard Heimel, Pieter Jurjen

AU - Oei, Swan Gie

PY - 2019/1/31

Y1 - 2019/1/31

N2 - AIM: We aimed to investigate if the risk of fetal distress during term labor is related to the intrapartum maternal hemoglobin (Hb) level. Second, we investigated the relation between mode of delivery, reason for instrumental delivery and short-term neonatal outcome and maternal Hb. Third, we aimed to identify factors influencing intrapartum maternal Hb level.METHODS: A retrospective cohort study was performed in a tertiary hospital in The Netherlands, including data from women who gave birth between 2009 and 2016. To determine whether the likelihood of fetal distress to occur was dependent on intrapartum Hb, multivariate regression models were run with intrapartum Hb as the main independent variable of interest. Hb was used as a continuous value. We repeated this procedure for the likelihood of instrumental vaginal delivery (IVD), cesarean section (CS), 5-min Apgar score < 7, and umbilical cord arterial pH ≤ 7.05 to occur. Also, we identified factors influencing intrapartum Hb level using linear regression analysis.RESULTS: Data of 9144 patients were analyzed. Intrapartum Hb did not contribute to the prediction of the likelihood of fetal distress, IVD for nonprogressive labor, CS for fetal condition, 5-min Apgar score < 7, and pHa ≤ 7.05. However, there was a unique statistically significant contribution of Hb to the prediction of the likelihood of IVD for any reason and IVD for fetal distress and CS for any reason and CS for nonprogressive labor. IVD for fetal distress was related to a higher intrapartum Hb level, whereas CS for nonprogressive labor was related to a lower intrapartum Hb level. Intrapartum Hb level was influenced by maternal age, ethnicity, parity, fetal sex, and birth weight.CONCLUSIONS: The risk of fetal distress and adverse neonatal outcome is not related to intrapartum Hb levels. However, our data suggest that mode of delivery is dependent on intrapartum Hb, as shown in a large tertiary population. We recommend further investigating this relation in a large prospective study.

AB - AIM: We aimed to investigate if the risk of fetal distress during term labor is related to the intrapartum maternal hemoglobin (Hb) level. Second, we investigated the relation between mode of delivery, reason for instrumental delivery and short-term neonatal outcome and maternal Hb. Third, we aimed to identify factors influencing intrapartum maternal Hb level.METHODS: A retrospective cohort study was performed in a tertiary hospital in The Netherlands, including data from women who gave birth between 2009 and 2016. To determine whether the likelihood of fetal distress to occur was dependent on intrapartum Hb, multivariate regression models were run with intrapartum Hb as the main independent variable of interest. Hb was used as a continuous value. We repeated this procedure for the likelihood of instrumental vaginal delivery (IVD), cesarean section (CS), 5-min Apgar score < 7, and umbilical cord arterial pH ≤ 7.05 to occur. Also, we identified factors influencing intrapartum Hb level using linear regression analysis.RESULTS: Data of 9144 patients were analyzed. Intrapartum Hb did not contribute to the prediction of the likelihood of fetal distress, IVD for nonprogressive labor, CS for fetal condition, 5-min Apgar score < 7, and pHa ≤ 7.05. However, there was a unique statistically significant contribution of Hb to the prediction of the likelihood of IVD for any reason and IVD for fetal distress and CS for any reason and CS for nonprogressive labor. IVD for fetal distress was related to a higher intrapartum Hb level, whereas CS for nonprogressive labor was related to a lower intrapartum Hb level. Intrapartum Hb level was influenced by maternal age, ethnicity, parity, fetal sex, and birth weight.CONCLUSIONS: The risk of fetal distress and adverse neonatal outcome is not related to intrapartum Hb levels. However, our data suggest that mode of delivery is dependent on intrapartum Hb, as shown in a large tertiary population. We recommend further investigating this relation in a large prospective study.

KW - Fetal distress

KW - instrumental delivery

KW - maternal hemoglobin

KW - neonatal outcome

KW - obstetric labor

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U2 - 10.1080/14767058.2019.1573221

DO - 10.1080/14767058.2019.1573221

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JO - Journal of Maternal-Fetal and Neonatal Medicine

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SN - 1476-7058

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