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General obstetrics
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How often is a low Apgar score the result of substandard care during labour?
Article first published online: 20 APR 2010
DOI: 10.1111/j.1471-0528.2010.02565.x
© 2010 The Authors Journal compilation © RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology
Issue
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 117, Issue 8, pages 968–978, July 2010
Additional Information
How to Cite
Berglund, S., Pettersson, H., Cnattingius, S. and Grunewald, C. (2010), How often is a low Apgar score the result of substandard care during labour?. BJOG: An International Journal of Obstetrics & Gynaecology, 117: 968–978. doi: 10.1111/j.1471-0528.2010.02565.x
Publication History
- Issue published online: 8 JUN 2010
- Article first published online: 20 APR 2010
- Accepted 10 March 2010. Published Online 21 April 2010.
- Abstract
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Keywords:
- Asphyxia;
- delivery;
- fetal surveillance;
- hyperstimulation;
- labour;
- oxytocin;
- substandard care;
- vacuum extraction.
Please cite this paper as: Berglund S, Pettersson H, Cnattingius S, Grunewald C. How often is a low Apgar score the result of substandard care during labour? BJOG 2010;117:968–978.
Objective To increase our knowledge of the occurrence of substandard care during labour.
Design A population-based case–control study.
Setting Stockholm County.
Population Infants born in the period 2004–2006 in Stockholm County.
Methods Cases and controls were identified from the Swedish Medical Birth Register, had a gestational age of ≥33 complete weeks, had planned for a vaginal delivery, and had a normal cardiotocographic (CTG) recording on admission. We compared 313 infants with an Apgar score of <7 at 5 minutes of age with 313 randomly selected controls with a full Apgar score, matched for year of birth.
Main outcome measure Substandard care during labour.
Results We found that 62% of cases and 36% of controls were subject to some form of substandard care during labour. In half of the cases and in 12% of the controls, CTG was abnormal for ≥45 minutes before birth. Fetal blood sampling was not performed in 79% of both cases and controls, when indicated. Oxytocin was provided without signs of uterine inertia in 20% of both cases and controls. Uterine contractions were hyperstimulated by oxytocin in 29% of cases and in 9% of controls, and the dose of oxytocin was increased despite abnormal CTG in 19% and 6% of cases and controls, respectively. Assuming that substandard care is a risk factor for low Apgar score, we estimate that up to 42% of the cases could be prevented by avoiding substandard care.
Conclusions There was substandard care during labour of two-thirds of infants with a low Apgar score. The main reasons for substandard care were related to misinterpretation of CTG, not acting on an abnormal CTG in a timely fashion and incautious use of oxytocin.