JMIR Publications

ABSTRACT

Background:

To analyze the association between the obstetric interventions during childbirth with the quality of GA information determining, according to the first antenatal ultrasound assessment, which assisted the calculation.

Objective:

To analyse the association between the quality of gestational age (GA) information and obstetric interventions during birth. Secondarily, to assess obstetric outcomes and the agreement between obstetricians and paediatricians who independently estimate GA

Methods:

Hospital-based cohort study with 2,113 medical records data of births at a perinatal referral center. The database was separated into groups and subgroups of analyses based on the reference used by obstetricians to obtain GA at birth. Maternal and neonatal characteristics, mode of delivery, oxytocin augmentation, forceps were compared between groups of pregnancies with GA determining assisted by different references:  obstetric ultrasound assessment <14 weeks, ≤20 weeks, and >20 weeks or without antenatal ultrasound. Ultrasound based-GA information was associated with outcomes between the interest groups using chi-square, odds ratio with 95% confidence intervals (CI), or Mann–Whitney statistical analysis.

Results:

The chance of non-spontaneous delivery was higher in pregnancies with <14 weeks ultrasound-based-GA, OR=1.64 (1.35 – 1.98, 95% CI), and ≤ 20 weeks ultrasound-based-GA, OR= 1.58 (1.31 – 1.90, 95% CI) when compared to the pregnancies with > 20 weeks ultrasound-based-GA or without antenatal ultrasound. The use of oxytocin for labor augmentation was higher OR=1.41 (1.09 – 1.82, 95% CI) and 1.34 (1.04 – 1.72, 95% CI), respectively, comparing the same pairs of groups. Moreover, maternal blood transfusion after birth was more frequent in births in witch GA determining was assisted with > 20 weeks ultrasound or without ultrasound than in the other groups, 3.1% vs. 1.5%, P= .020, for < 14 weeks ultrasound-based-GA, and 3.1% vs. 1.7%, P= .048, for ≤ 20 weeks ultrasound-based-GA. Cesarean section rate (40.8% vs. 37.1%, P= .121; and 40.1% vs. 37.1%, P= .195) and forceps (6.0% vs 4.1%, P= .187; and 5.2% vs 4.1%, P= .415) were similar between such groups of comparisons. Neonatal intensive care unit (NICU) admission was more frequent in newborns with > 20 weeks ultrasound-based-GA or without ultrasound than in the other groups, excluding stillbirths and major fetal malformations (18.1% vs. 13.2%, P= .010, and 18.1% vs. 13.3%, P= .008).

Conclusions:

The present analysis highlighted relevant points of healthcare to improve obstetric care to achieve lower maternal and neonatal morbidity at birth, confirming the importance of early access to technologies for pregnancy dating as an essential component of quality in antenatal care.