Article

Apgar Score of Zero at Five Minutes and Neonatal Seizures or Serious Neurologic Dysfunction in Relation to Birth Setting.

Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, New York. Electronic address: .
American journal of obstetrics and gynecology (Impact Factor: 3.28). 06/2013; DOI: 10.1016/j.ajog.2013.06.025
Source: PubMed

ABSTRACT To examine the occurrence of 5-minute Apgar scores of zero and seizures or serious neurologic dysfunction for four groups by birth setting and birth attendant (hospital physician, hospital midwife, free-standing birth center midwife, and home midwife) in the United States from 2007-2010.
Data from the United States Centers for Disease Control's National Center for Health Statistics birth certificate data files were used to assess deliveries by physicians and midwives in and out of the hospital for the 4-year period from 2007-2010 for singleton term births (≥37 weeks gestation) and ≥2,500 grams. Five-minute Apgar scores of zero and neonatal seizures or serious neurologic dysfunction were analyzed for four groups by birth setting and birth attendant (hospital physician, hospital midwife, free-standing birth center midwife, and home midwife).
Home births (RR 10.55) and births in free-standing birth centers (RR 3.56) attended by midwives had a significantly higher risk of a 5-minute Apgar score of zero (p<.0001) than hospital births attended by physicians or midwives. Home births (RR 3.80) and births in free-standing birth centers attended by midwives (RR 1.88) had a significantly higher risk of neonatal seizures or serious neurologic dysfunction (p<.0001) than hospital births attended by physicians or midwives.
The increased risk of 5-minute Apgar score of zero and seizures or serious neurologic dysfunction of out-of-hospital births should be disclosed by obstetric practitioners to women who express an interest in out-of-hospital birth. Physicians should address patients' motivations for out-of-hospital delivery by continuously improving safe and compassionate care of pregnant, fetal, and neonatal patients in the hospital setting.

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