Open AccessNeonatal outcomes after the obstetric near‐miss events uterine rupture, abnormally invasive placenta and emergency peripartum hysterectomy – prospective data from the 2009–2011 Finnish NOSS study
Author(s) -
Jakobsson Maija,
Tapper AnnaMaija,
Palomäki Outi,
Ojala Kati,
Pallasmaa Nanneli,
Ordén MaijaRiitta,
Gissler Mika
Publication year - 2015
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.12780
Subject(s) - medicine , obstetrics , uterine rupture , odds ratio , hysterectomy , asphyxia , pregnancy , prospective cohort study , umbilical artery , gynecology , pediatrics , gestation , surgery , uterus , biology , genetics
Neonatal outcomes after the maternal obstetric near‐miss complications of uterine rupture, abnormally invasive placenta, and emergency peripartum hysterectomy were assessed. Material and methods This case‐control study was conducted as part of the Nordic Obstetric Surveillance Study ( NOSS ). Data on 211 newborns from 197 deliveries in which an obstetric near‐miss complication was involved, were collected prospectively from April 2009 to August 2011 from all Finnish delivery units via questionnaires. Missing cases were obtained from national health registers and confirmed by the clinics. Control populations consisted of all other children born during the same period of time in the Finnish Medical Birth Register ( n = 147 551). Results The number of stillbirths in this cohort was high [ n = 8, 3.8% vs. 0.3% among controls, odds ratio ( OR ) 12.5, 95% confidence interval ( CI ) 6.32–24.9]. In addition, there were two neonatal deaths. The majority of cases ( n = 8, 80%) were connected to uterine rupture. The risk of severe birth asphyxia diagnosis was increased compared with controls ( n = 17, 8.1% vs. 0.1%, OR 137, 95% CI 82.7–226). A low umbilical artery pH (<7.05) was also observed among these neonates (28.8% vs. 1.0%, OR 28.7, 95% CI 21.5–38.2). Post‐term pregnancies were relatively common among the uterine rupture cases. Adverse neonatal outcomes in the AIP and emergency peripartum hysterectomy cases were associated with preterm deliveries. Conclusions The prospective data collected from clinicians, combined with the information gathered from national health registers, provided valuable insights into rare maternal near‐miss cases. These complications also predisposed stillbirth and neonatal death. In this study, 75% of fetal losses were associated with uterine rupture.