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The cumulative incidence of neonatal metabolic acidemia after terminal bradycardia in the 2nd stage of labor: a survival-based model

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

The aim of the study was to estimate by a survival analysis model the hazard function (HF) for neonatal metabolic acidemia (MA) throughout the 2nd stage of labor (2STG) at the time of occurrence of a terminal bradycardia ≥ 10 min requiring expedited delivery, and the cumulative incidence function (CIF) for MA according with the duration of bradycardia stratified in 10–12 min and > 12 min.

Methods

Singleton pregnancies experiencing terminal fetal bradycardia requiring expedited delivery in the 2STG at 38 + 0–41 + 3 weeks and delivering in the year 2019, were identified. The presence of MA (pH < 7 and/or BE ≤ − 12 mmol/L) was determined based on the acid–base status in the umbilical artery cord blood. Survival analysis was used to assess the hazard function (HF) and the cumulative incidence function (CIF) for MA occurring after terminal fetal bradycardia, at the 2STG.

Results

Out of a non-consecutive population of 12,331 pregnancies, there were 52 cases that fit the inclusion criteria. Twenty-four (46.2%) of those develop MA. Abnormal quantitative pH values and the HF for MA correlated with the duration of 2STG at the time of bradycardia onset, but not with bradycardia duration. After 60 min of duration of 2STG, the HF (or instantaneous rate of failure) increased dramatically (from 1.2 to 20 about at 120 min). At paired duration of 2STG, a higher CIF was observed for the terminal bradycardia > 12 min.

Conclusion

Forty-six percent of term fetuses with terminal bradycardia had MA at birth. Despite the low sensitivity and a non-significant association with quantitative pH values, the duration of terminal bradycardia in the 2STG is associated with a higher CIF for MA.

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Abbreviations

FHR:

Fetal heart rate

2STG:

2nd stage of labor

CTG:

Cardiotocography

MA:

Metabolic acidemia

CSH:

Cause-specific hazard

CIF:

Cumulative incidence

HR:

Hazard ratio

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy

    Anna Seidenari & Antonio Farina

  2. Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, University Vita-Salute, Milan, Italy

    Paolo Ivo Cavoretto, Gerarda Gaeta & Massimo Candiani

  3. Unit of Obstetrics, Department of Woman, Child and Neonate, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Mangiagalli Center, Milan, Italy

    Ilma Floriana Carbone, Enrico Iurlaro, Giulia Emily Cetera & Daniela Denis Di Martino

  4. Department of Surgical Sciences, Sant’Anna Hospital, University of Turin, Turin, Italy

    Chiara Germano & Bianca Masturzo

  5. Department of Obstetrics and Gynecology, S. Antonio Abate Hospital, Trapani, Italy

    Silvia Amodeo & Laura Giambanco

  6. Section of Obstetrics and Gynecology, Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliero-Universitaria S. Anna, University of Ferrara, Cona, Ferrara, Italy

    Danila Morano

Authors
  1. Anna Seidenari
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  2. Paolo Ivo Cavoretto
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  3. Ilma Floriana Carbone
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  4. Chiara Germano
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  6. Gerarda Gaeta
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  7. Giulia Emily Cetera
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  8. Silvia Amodeo
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  9. Danila Morano
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  10. Bianca Masturzo
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  11. Daniela Denis Di Martino
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  12. Laura Giambanco
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  13. Massimo Candiani
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  14. Antonio Farina
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Contributions

AF: project development, conceptualization, methodology, software, validation, data analysis, supervision, resources, and manuscript writing (draft and revisions); PIC: conceptualization, methodology, manuscript writing (draft and revisions), visualization, and supervision; AS: data collection, visualization, and manuscript writing (draft and revisions); IFC: data collection and supervision; EI: supervision; CG: data collection, visualization, and writing (draft and revision); GG: data collection, visualization; GEC: data collection; DDDM: data collection; BM: resources and supervision; DM: conceptualization, resources, supervision; SA: data collection; LG: resources; MC: resources and supervision.

Corresponding author

Correspondence to Danila Morano.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This retrospective study was approved by the Local Ethics Committee of the Sant’Orsola Malpighi Hospital and conducted in agreement with ethical standards for human research established by the Declaration of Helsinki. The Ethics Committee code is DePreCar 805/2019.

Consent to participate

Informed consent was waived by Local Ethics Committee of the Sant’Orsola Malpighi Hospital due to retrospective nature of the study.

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Not applicable.

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Seidenari, A., Cavoretto, P.I., Carbone, I.F. et al. The cumulative incidence of neonatal metabolic acidemia after terminal bradycardia in the 2nd stage of labor: a survival-based model. Arch Gynecol Obstet 307, 1407–1414 (2023). https://doi.org/10.1007/s00404-022-06619-9

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  • DOI: https://doi.org/10.1007/s00404-022-06619-9

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