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Admission test and pregnancy outcome.

Background: The admission test (AT) has been carried out for many years, but there are still debates about the prognostic value of the test. Therefore, we aimed to examine the value of the AT in predicting the adverse outcome in neonates.

Methods: In this cross-sectional study, 425 pregnant women with normal vaginal delivery were studied between2009 and 2014at Vali-e-Asr Hospital. Based on the results, the women were divided into 2groups of normal and abnormal ATs. All the patients were followed up until the birth of their baby, when the status of mother and neonate was determined. The main outcomes of the study were cesarean rate, neonatal intensive care unit (NICU) admission, fetus demise, neonatal acidosis, and Apgar score. The independent t-test, chi-square test, Fisher exact test, and logistic regression were used for statistical analysis. The data were analyzed using SPSS (version 17).

Results: Of425 pregnant women studied, 142 (33.4%) had abnormal ATs with a mean age of 29 ([+ or -]4.5) years. Multivariate analysis showed that an abnormal AT was able to predict the incidence of cesarean section, intrauterine growth restriction, turned cord, and Apgar<7, but it could not predict neonatal death and hypoxia.

Conclusion: The AT was shown to be a useful screening test with risk factors such as oligohydramnios, bloody amniotic fluid, meconium amniotic fluid, intrauterine growth restriction, and turned cord. Additionally, the test was also able to predict NICU admission and the need for cesarean section, but it could not predict the occurrence of neonatal death.

Please cite this article as: Akhavan S, Lak P, Rahimi-Sharbaf F, Mohammadi SR, Shirazi M. Admission Test and Pregnancy Outcome. Iran J Med Sci. 2017;42(4):362-368.

Keywords * Infant * Outcome * Admission test * Electronic fetal monitoring * Cardiotocography

Introduction

Obstetricians and gynecologists are always interested in predicting the prognosis for neonates during delivery. The fetus may experience hypoxia and injuries caused by stress and contraction during the course of labor. (1) The occurrence of hypoxia during or before labor can lead to complications such as mental retardation, cerebral palsy, and paralysis of the infant; therefore, diagnoses and prompt responses are critical and vital for both fetus and mother. (1,2)

In developed countries, continuous monitoring of fetal heart rate (FHR) is drawn upon as a tool to identify the risk of asphyxia during labor and the method is broadly applied nowadays. Generally, FHR is measured through internal and external methods. The external method is used more often because it does not need the connection of the electrodes to the fetus. (1,2)

The admission test (AT) is a method that has recently been introduced and employed in some countries. (2) The patterns of the AT are depicted in table 1. This method can monitor external FHR for 20 minutes upon the admission of a pregnant woman. (3) Although this type of assessment is considered noninvasive, it is not mandatory and can be used for the triage of high-risk fetuses. (4) Gurung et al. (5) studied the method and concluded that the test was useful for assessing the current status of the fetus. They also showed that this test could be a predictor of the neonate's well-being in the early hours of birth. However, some studies have reported that the test is inefficient in improving neonatal outcomes. (6) There are still debates over the effectiveness of this test in predicting the fetal outcome. (2,4,6,7)

In some developed countries, the AT may not have a significant effect in improving the prognosis of infants because neonates receive good antenatal care and have access to proper facilities such as intrapartum fetal monitoring and fetal blood sampling. However, in developing countries, this test may be a useful tool. (4) The occurrence of hypoxia during or before labor can give rise to complications such as mental retardation and cerebral palsy. Obstetricians and gynecologists are always interested in predicting the prognosis for neonates during delivery. In developed countries, fetal monitoring (AT) is utilized to identify the risk of asphyxia before labor. Although the test has been carried out for many years, there are still debates about the predictive value of the test. Accordingly, this study was aimed to examine the value of the test in predicting the adverse outcome in neonates.

Patients and Methods

This cross-sectional study, conducted between 2009 and 2014in Vali-e-Asr Hospital, Tehran, included 425 pregnant women who attended the labor ward in the hospital. The sample size was calculated according to alpha error and power of 5% and 90%, respectively, and prevalence of the unfavorable outcome in nonreactive and reactive ATsof55% and 38%, correspondingly. The primary sample size was 133 mothers in each group. We evaluated 142 nonreactive ATs and 283 reactive ATs.

The inclusion criteria covered all full-term pregnant women who were admitted to the labor ward for vaginal delivery, whereas the exclusion criteria consisted of inaccurate gestational age, placenta previa, cord prolapse, previous cesarean section, preterm birth, suspected cephalopelvic disproportion, and any limitation on vaginal delivery.

Informed consent was obtained from the mothers enrolled in the study. The study was approved by the Perinatal Committee of Tehran University of Medical Sciences. The AT was performed through completed questionnaires for the participants, and the results were interpreted by 2obstetricians and gynecologists. The intra- and inter observer reliability was >87% and >85%, respectively, based on the results obtained from the AT.

First, the women visiting the labor ward with labor pain had a detailed history-taking, followed by a thorough physical examination. After the consideration of the inclusion and exclusion criteria, short electronic FHR tracing was performed simultaneously with uterine activity for 20 minutes (8,9) and was called "the AT". If the test was normal (table1), intermittent auscultation was performed to monitor FHR (every 30 min in stage I of labor and 15 min in stage II with a duration of 1 min).

As is shown in table 1, abnormal ATs were divided into indeterminable and ominous patterns. (10-13) If the AT was ominous, immediate delivery was performed via a favorable method. In the indeterminable AT group (table1), the women received oxygen and intravenous fluids in the left lateral decubitus position and were monitored for 20 minutes again and reclassified. The normal and indeterminable pattern groups were considered for normal vaginal delivery. If the ominous pattern persisted or if the indeterminable pattern and normal AT groups had significant variations as well as prolonged or late decelerations in the absence of beat-to-beat variability, then cesarean section was performed.

All the patients were followed up until the birth of their babies, when the status of both mother and neonate was determined.

The main outcomes of the study were cesarean rate, neonatal intensive care unit (NICU) admission, fetus demise, neonatal acidosis, and Apgar score. Amniotic fluid volume was estimated subjectively at the end of delivery (cesarean section or normal vaginal delivery) and if our estimation showed a volume <500 cc, the term "oligohydramnios" was used to describe this situation. (14)

Univariate analysis was conducted using the independent t test, chi-square test, and Fisher exact test to examine the relationship between abnormal ATs and the other studied variables. Variables with a significance level <0.25 were entered into multivariate analysis, performed by logistic regression. The AT was considered a dependent variable, and the other factors were included in the model as independent variables. A P<0.05 was considered statistically significant. The data were analyzed using SPSS (version 17).

Results

Totally, 425 pregnant women were studied. The results of the study are shown in tables 2 and 3. There were no statistically significant differences between the participants' age and their gestational age, mean cord blood pH, induction of labor, neonatal mortality, and intrauterine fetal demise between the 2 groups (table 2).

The Apgar scores at minutes 1 and 5in the abnormal AT group were lower than those in the normal AT group.

Multivariate analysis showed that an abnormal AT was able to predict the incidence of cesarean section, intrauterine growth restriction (IUGR), turned cord, and Apgar<7, but it could not predict neonatal death and hypoxia (table 3).

Discussion

In the present study, the AT was unable to predict the occurrence of neonatal death because there were relationships between some variables and our multivariate analysis was unable to predict these variables in the model. Nonetheless, the AT, as a rapid assessment, can be useful in identifying risk factors in pregnant women. Moreover, research has previously shown that the AT can demonstrate the status of oxygen transfer from the placenta to the fetus through heart rhythm. (6) There is controversy surrounding the efficacy of this test, and no consensus exists on its real prognostic value among different groups of pregnant women. Some researchers have considered it useful in all groups, while others have found it useful just for high-risk pregnant women. In a study by Gurung et al., (5) the results of the AT were reported normal in 73% and abnormal in 27% of the pregnant women. In their study, the patients with an abnormal test were at a higher risk of intrapartum fetal distress, cesarean section, requiring resuscitation, and NICU admission. The Apgar score at minute 1did not differ between the 2groups of normal and abnormal ATs, but the Apgar score at minute 5 in the abnormal AT group was significantly less than that in the other group. Their study had a small sample size of 100 patients. Another study also showed similar results. (7)

Blix et al. (15) revealed that the AT was not significantly efficient for low-risk pregnant women and it did not fully predict poor outcomes. In some cases, a highly abnormal AT led to surgical interventions such as cesarean section; however, it did not change neonatal outcomes. Another study, showing that perinatal morbidity was higher in women with an abnormal AT, concluded that the application of the AT for high-risk groups could be useful for predicting fetal well-being. (16) Other studies have confirmed the efficacy of the test in predicting intrauterine fetal asphyxia, (17) fetal distress, and the need for NICU admission. (6) Perveen et al. (18) reportedthat 75% of their pregnant women, who were admitted for delivery, had a normal AT and that fetal distress and the need for resuscitation were more prevalent in the group with an abnormal AT.

In a study by Rahman et al., (19) about 77% of the patients had a normal AT. In their study, fetal distress, NICU admission, and moderate/thick meconium were more prevalent in the group with an abnormal AT, but this group had lower rates of vaginal birth. The authors concluded that the test was noninvasive and inexpensive and it could be useful for high-risk groups. Nonetheless, the test can be used for initial screening, diagnosis of the fetus at risk, and application of intrapartum fetal monitoring and has a satisfactory predictive power for both fetal distress and the need for NICU admission. (20)

In a study by Sandhu et al., (6) 67% of the pregnant women before delivery had a normal AT. In addition, the authors showed that whereas the test had high specificity for predicting fetal distress, its sensitivity was low. Mires et al. (21) showed that the women with an abnormal AT required more continuous FHR monitoring in labor (OR=1.49), augmentation of labor (OR=1.26), epidural analgesia (OR=1.33), and operative delivery (OR=1.36). Impey et al. (22) revealedthat the AT did not improve outcomes related to infant mortality and morbidity such as cesarean section and Apgar score and that its application might increase some of the other procedures. The investigators compared the test with routine care and conducted a randomized clinical trial with a large sample size among low-risk individuals. In a study by Patel et al., (23) fetal and maternal outcomes such as fetal distress (55.6% vs. 6.4%), meconium stained (44.4% vs. 7.7%), cesarean section (66.7% vs. 14.8%), and NICU admission (44.4% vs. 2.4%) were higher in the nonreactive group than in the reactive group.

In another study by Rajalekshmi et al. (8) on over 400 pregnant women, 267 (66.75%) of the patients had reactive tracings, 114 (28.5%) indeterminable tracings, and 19 (4.75%) ominous tracings. Since admission cardiotocography can assess early fetal risks, early intervention can lessen fetal mortality and morbidity. The study showed a good correlation between reactive tracings and good fetal outcomes even with less frequent monitoring. Consequently, the AT can be used as a useful tool to analyze cardiotocography tracings of women in early labor with a view to providing high-quality care and predicting the delivery mode and the fetal outcome. In this study, the sensitivity and specificity of the test were computed to be 92.85% and 94.16%, respectively.

Santosh et al. (9) evaluated over 200 women with the AT and reported that the incidence of fetal distress, meconium fluid, need for resuscitation, and need for NICU admission were significantly more frequent among the patients with ominous test results than among those with indeterminable or reactive test results on admission. The authors also demonstrated that the incidence increased as the test changed from reactive to indeterminable and ominous. It seems that the test value was dependent on the type of patients and the availability of other facilities. In countries where suitable facilities are available, this test does not change neonatal outcomes since fetuses with problems can be quickly identified. Conversely, in countries without proper tools or with lower levels of practice, this test may show its relative superiority.

The use of the AT as a method for the routine evaluation of pregnant women is still somewhat controversial. It seems that this test may be able to predict certain outcomes, but it cannot predict important outcomes such as fetal death and is, thus, unable to rule out the risk of fetal death. The lack of difference between the 2 groups in terms of fetal death may have resulted from the early termination of pregnancy in the abnormal AT group. An abnormal AT could be as a result of primary fetal distress, which causes abnormal newborn's blood gas and PH compared with the normal AT group. A noteworthy drawback to the test is that the physician or midwife may report the test abnormal so as to avoid legal issues and longer follow-up of the patient, leading to unnecessary cases of cesarean section. (24) The main limitation of this study is its cross-sectional design. We suggest that cohort or clinical trial methods be applied for the evaluation of AT relevancy and applicability. It is, however, deserving of note that while we conducted multivariate analysis in our study, the previous studies did not employ this analytical modality. Multivariate analysis can decrease confounding in the results.

Conclusion

The AT is useful in some situations such as oligohydramnios, IUGR, bloody amniotic fluid, and meconium amniotic fluid. Additionally, an abnormal AT can forecast high incidence of cesarean section, NICU admission, and turned cord, but it cannot predict the occurrence of neonatal death. It seems that early termination of pregnancy in a nonreassuring AT can prevent fetal demise and fetal acidosis; hence, there is no significant deference in fetal death and umbilical cord PH between normal and abnormal ATs. Accordingly, in a nonreassuring AT, after taking initial steps for augmenting fetal oxygenation, we can improve fetal situation. In this study, if the patient failed to respond to the initial measures, we performed caesarean section immediately. As a result, the abnormal AT group was associated with IUGR, lower Apgar score, and more cases of cesarean section. However, with accurate and timely intervention, adverse outcomes such as fetal acidosis and fetal demise were not more than those in the normal AT group.

Acknowledgement

This research has been supported by Tehran University of Medical Sciences and Health Services grant 26266.

Conflict of Interest: None declared.

References

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(2.) Devane D, Lalor JG, Daly S, McGuire W, Smith V. Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing. Cochrane Database Syst Rev. 2012:CD005122. doi: 10.1002/14651858. CD005122.pub4. PubMed PMID: 22336808.

(3.) Phelan JP. Labor admission test. Clin Perinatol. 1994;21:879-85. PubMed PMID: 7882649.

(4.) Mires G, Williams F, Howie P. Randomised controlled trial of cardiotocography versus Doppler auscultation of fetal heart at admission in labour in low risk obstetric population. BMJ. 2001;322:1457-60. PubMed PMID: 11408301; PubMed Central PMCID: PMC32308.

(5.) Gurung G, Rana A, Giri K. Detection of intrapartum fetal hypoxia using admission test (AT). Nepal Journal of Obstetrics and Gynaecology. 2009;1:10-3. doi: 10.3126/njog.v1i2.1487.

(6.) Sandhu GS, Raju R, Bhattacharyya TK. Admission Cardiotocography Screening of High Risk Obstetric Patients. Med J Armed Forces India. 2008;64:43-5. doi: 10.1016/S0377-1237(08)80145-1.

(7.) Elimian A, Lawlor P, Figueroa R, Wiencek V, Garry D, Quirk JG. Intrapartum assessment of fetal well-being: Any role for a fetal admission test? J Matern Fetal Neonatal Med. 2003;13:408-13. doi: 10.1080/jmf.13.6.408.413. PubMed PMID: 12962267.

(8.) Rajalekshmi M, Chithra J, Nithya R, Vijay N. Admission Cardiotocography as a screening Test to predict fetal outcome and mode of delivery. Indian Journal of Obstetrics and Gynecology Research. 2016; 3:43-50.

(9.) Bhangdiya S, Dadhe K, Khatod L. Labor admission test (cardiotocography) as intrapartum risk screening test and its efficacy to predict fetal outcome. International Journal of Recent Trends in Science and Technology. 2015; 16:459-62.

(10.) Bloom S, Corton MM, Spong CY, Dashe J, Leveno K. Williams Obstetrics. 24th ed. New York: McGraw-Hill Education; 2014. 1376 p.

(11.) Lyndon A, Ali LU. Fetal Heart Monitoring Principles and Practices. 4th ed. Dubuque, IA: Kendall Hunt Professional; 2009. 335 p.

(12.) Debdas AK. Practical Cardiotocography. 3rd ed. Haryana: JP Medical Ltd; 2013. 331 p.

(13.) Figueras F, Martinez JM, Puerto B, Coll O, Cararach V, Vanrell JA. Contraction stress test versus ductus venosus Doppler evaluation for the prediction of adverse perinatal outcome in growth-restricted fetuses with non-reassuring non-stress test. Ultrasound Obstet Gynecol. 2003;21:250-5. doi: 10.1002/uog.60. PubMed PMID: 12666219.

(14.) Ghidini A, Schiliro M, Locatelli A. Amniotic fluid volume: When and how to take action [Internet].Ohio: ContemporaryObstetrics and Gynecology; c2014. Available from: http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/content/tags/amniotic-fluid-volume/amniotic-fluid-volume-when-and-how-take-action?page=full.

(15.) Bix E, Reiner LM, Klovning A, Oian P. Prognostic value of the labour admission test and its effectiveness compared with auscultation only: A systematic review. BJOG. 2005;112:1595-604. doi: 10.1111/j.1471-0528.2005.00766.x. PubMed PMID: 16305561.

(16.) Kulkarni AA, Shrotri AN. Admission test: A predictive test for fetal distress in high risk labour. J Obstet Gynaecol Res. 1998;24:255-9. doi: 10.1111/j.1447-0756.1998.tb00086.x. PubMed PMID: 9798354.

(17.) Libiran MJ, Solis MS, Santos RR, Baga EB. Admission test as predictor of intrauterine fetal asphyxia. Philipp J Obstet Gynecol. 1999;23:143-9. PubMed PMID: 12179669.

(18.) Perveen S, Hashmi H. Effectiveness of Admission Test. J Dow Univ Health Sci. 2007;1:20-5.

(19.) Rahman H, Renjhen P, Dutta S, Kar S. Admission cardiotocography: Its role in predicting foetal outcome in high-risk obstetric patients. Australas Med J. 2012;5:522-7. doi: 10.4066/AMJ.2012.1267. PubMed PMID: 23173014; PubMed Central PMCID: PMC3494822.

(20.) Bix E, Reiner LM, Klovning A, Oian P. Prognostic value of the labour admission test and its effectiveness compared with auscultation only: A systematic review. BJOG. 2005;112:1595-604. doi: 10.1111/j.1471-0528.2005.00766.x. PubMed PMID: 16305561.

(21.) Mires GJ, Williams FL, Howie PW. The Admission Test: Of value in 'low risk' labour [abstract]. In: Gardosi J, Arulkumaran S, editors. 6th International symposium on intrapartum surveillance; 2001 july 8-10; Birmingham,UK. London: National Institute for Clinical Excellence; 2001. p 14.

(22.) Impey L, Reynolds M, MacQuillan K, Gates S, Murphy J, Sheil O. Admission cardiotocography: A randomised controlled trial. Lancet. 2003;361:465-70. doi: 10.1016/S0140-6736(03)12464-6. PubMed PMID: 12583945.

(23.) Patel S, Gupta S, Modi K, Desai A, Shah S, Pamnani D. Correlation of Admission NST in Low Risk Pregnancy with Neonatal Outcome. American Journal of Ethnomedicine. 2015;2:79-83.

(24.) Blix E, Ohlund LS. Norwegian midwives' perception of the labour admission test. Midwifery. 2007;23:48-58. doi: 10.1016/j.midw.2005.10.003. PubMed PMID: 16876922.

Setareh Akhavan (1), MD;

Parvaneh Lak (2), MD;

Fatemeh Rahimi-Sharbaf (1), MD;

Seyed Rahim Mohammadi (3), MD;

Mahboobeh Shirazi (4), MD

(1) Department of Gynecology, Tehran University of Medical Sciences, Tehran, Iran;

(2) Department of Obstetrics and Gynaecology, Shaheed Chamran Hospital, Iran University of Medical Sciences, Tehran, Iran;

(3) Tehran University of Medical Sciences, Tehran, Iran;

(4) Maternal Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran

Correspondence:

Mahboobeh Shirazi, MD;

Department of Obstetrics and Gynaecology, Yas Hospital, Karim Khan Blvd, Ostad Nejatollahi St, Tehran, Iran

Tel: +98 912 3903352

Fax: +98 21 88948217

Email: mahboobeh.shirazi@yahoo.in

Received: 23 January 2016

Revised: 13 April 2016

Accepted: 24 April 2016

What's Known

* Many studies have shown that admission test (cardiotocography) could determine pregnancy outcomes, but other studies have not confirmed such results. There are major disagreements regarding the benefits of this test.

What's New

* Admission test can be used for screening many outcomes such as bloody amniotic fluid, meconium amniotic fluid, NICU admission and turned cord, but it cannot predict the occurrence of neonatal death. It seems that, in countries with a weak economy and poor medical facilities, the use of this test can be helpful in labor management.
Table 1: Three-tier fetal heart rate interpretation system Category of
FHR tracings

Category of FHR tracings

Normal pattern or category I, comprising           * Baseline rate:
                                                   110-160 bpm
                                                   * Baseline FHR
                                                   variability:
                                                   moderate
                                                   * Late or variable
                                                   decelerations:
                                                   absent
                                                   * Early
                                                   decelerations:
                                                   present or absent
                                                   * Accelerations:
                                                   present or absent
Indeterminable pattern or suspicious pattern       * Bradycardia not
or category II, comprising FHR tracing not         accompanied by
categorized as category I or III                   absent baseline
                                                   variability
                                                   * Tachycardia
                                                   * Minimal baseline
                                                   variability
                                                   * Absent baseline
                                                   variability not
                                                   accompanied by
                                                   recurrent
                                                   decelerations
                                                   * Marked baseline
                                                   variability
                                                   * Absence of
                                                   induced
                                                   accelerations
                                                   after fetal
                                                   stimulation
                                                   * Recurrent
                                                   variable
                                                   decelerations
                                                   accompanied by
                                                   minimal or moderate
                                                   baseline
                                                   variability
                                                   * Prolonged
                                                   deceleration>2 min
                                                   but<10 min
                                                   * Recurrent late
                                                   decelerations with
                                                   moderate baseline
                                                   variability
                                                   * Variable
                                                   decelerations
                                                   with other
                                                   characteristics
                                                   such as slow
                                                   return to
                                                   baseline,
                                                   "overshoots", and
                                                   "shoulders"
Ominous pattern or category III, including either  * Absent baseline
                                                   FHR variability
                                                   and any of the
                                                   following:
                                                   -Recurrent late
                                                   decelerations
                                                   -Recurrent variable
                                                   decelerations
                                                   -Bradycardia
                                                   * Sinusoidal
                                                   pattern

FHR: Fetal heart rate

Table 2: Univariate analysis of the relationship between an abnormal
admission test and the studied variables

Variables                           Normal (N=283)

Age                                   29 ([+ or -]5.5)
Gestational age                       38.5 ([+ or -]1.9)
Fetal weight                        3163.3 ([+ or -]614.5)
Oligohydramnios ([dagger])            20 (7.1%)[pounds sterling]
Bloody amniotic fluid ([dagger])       8 (2.8%)
Meconium amniotic fluid ([dagger])    31 (11%)
Prolonged deceleration ([dagger])      4 (1.4%)
Variable deceleration ([dagger])      11 (3.9%)
Late deceleration ([dagger])           1 (0.4%)
Cesarean ([dagger])                   50 (17.7%)
Slow return to base ([dagger])         5 (1.8%)
IUGR ([dagger])                        8 (2.8%)
NICU admission ([dagger])             30 (10.6%)
Induction ([dagger])                 137 (48.4%)
Turned cord ([dagger])                29 (10.3%)
Neonatal death or IUFD ([dagger])      4 (1.4%)
Apgar minute 1                         8.6 ([+ or -]0.9)
Apgar minute 5                         8.9 ([+ or -]0.6)
PH                                     7.37([+ or -]0.06)

Variables                           Abnormal (N=142)

Age                                   28.9 ([+ or -]5)
Gestational age                       38.3 ([+ or -]2.2)
Fetal weight                        3009.2 ([+ or -]720.8)
Oligohydramnios ([dagger])            28 (19.7%)[pounds sterling]
Bloody amniotic fluid ([dagger])      12 (8.5%)
Meconium amniotic fluid ([dagger])    29 (20.4%)
Prolonged deceleration ([dagger])     18 (12.7%)
Variable deceleration ([dagger])      31 (21.8%)
Late deceleration ([dagger])          19 (13.4%)
Cesarean ([dagger])                   81 (57%)
Slow return to base ([dagger])        19 (13.4%)
IUGR ([dagger])                       24 (16.9%)
NICU admission ([dagger])             33 (23.2%)
Induction ([dagger])                  58 (40.8%)
Turned cord ([dagger])                46 (32.4%)
Neonatal death or IUFD ([dagger])      3 (2.1%)
Apgar minute 1                         8 ([+ or -]1.3)
Apgar minute 5                         8.7 ([+ or -]1.1)
PH                                     7.31 ([+ or -]0.11)

Variables                           OR (95% CI)

Age                                  -
Gestational age                      -
Fetal weight                         -
Oligohydramnios ([dagger])           3.23 (1.74-5.97)
Bloody amniotic fluid ([dagger])     3.17 (1.26-7.95)
Meconium amniotic fluid ([dagger])   2.08 (1.2-3.62)
Prolonged deceleration ([dagger])   10.12 (3.35-30.53)
Variable deceleration ([dagger])     6.9 (3.35-14.22)
Late deceleration ([dagger])        43.56 (5.76-329)
Cesarean ([dagger])                  6.18 (3.94-9.71)
Slow return to base ([dagger])       8.59 (3.13-23.52)
IUGR ([dagger])                      6.7 (3.05-16.01)
NICU admission ([dagger])            2.55 (1.48-4.39)
Induction ([dagger])                 0.73 (0.49-1.1)
Turned cord ([dagger])               4.18 (2.48-7.03)
Neonatal death or IUFD ([dagger])    1.5 (0.33-6.81)
Apgar minute 1                       -
Apgar minute 5                       -
PH                                   -

Variables                           P value

Age                                  0.803
Gestational age                      0.377
Fetal weight                         0.022
Oligohydramnios ([dagger])          <0.001 ([dagger])
Bloody amniotic fluid ([dagger])     0.01 ([dagger])
Meconium amniotic fluid ([dagger])   0.008 ([dagger])
Prolonged deceleration ([dagger])   <0.001 ([dagger])
Variable deceleration ([dagger])    <0.001 ([dagger])
Late deceleration ([dagger])        <0.001 ([dagger])
Cesarean ([dagger])                 <0.001 ([dagger])
Slow return to base ([dagger])      <0.001 ([dagger])
IUGR ([dagger])                     <0.001 ([dagger])
NICU admission ([dagger])            0.001 ([dagger])
Induction ([dagger])                 0.14
Turned cord ([dagger])              <0.001 ([dagger])
Neonatal death or IUFD ([dagger])    0.691
Apgar minute 1                      <0.001 ([dagger])
Apgar minute 5                       0.02 ([dagger])
PH                                  <0.001 ([dagger])

([dagger]) Categorical variables according to Yes or No; ([dagger])
Statistically significant differences; [pounds sterling] Were
determined subjectively;
IUGR: Intrauterine growth restriction; NICU: Neonatal intensive-care
unit; IUFD: Intrauterine fetal death

Table 3: Multivariate analysis for the relationship between an
abnormal admission test and the studied variables

Variables                          B       S.E.   Wald

Oligohydramnios[pounds sterling]   0.506   0.399   1.609
Bloody amniotic fluid              0.500   0.547   0.836
Cesarean                           1.349   0.275  24.065
IUGR                               1.148   0.562   4.166
Turned cord                        0.941   0.306   9.427
NICU admission                    -0.546   0.451   1.463
Fetus death                       -0.494   0.988   0.250
Apgar<7                            0.805   0.285   7.959
PH<7.25                            0.081   0.504   0.026

Variables                         P value            Adjusted OR

Oligohydramnios[pounds sterling]   0.205                 1.659
Bloody amniotic fluid              0.361                 1.649
Cesarean                          <0.001 ([dagger])      3.852
IUGR                               0.041 ([dagger])      3.151
Turned cord                        0.002 ([dagger])      2.562
NICU admission                     0.226                 0.579
Fetus death                        0.617                 0.610
Apgar<7                            0.005 ([dagger])      2.236
PH<7.25                            0.872                 1.084

Variables                         OR (95% CI)
                                  Lower  Upper

Oligohydramnios[pounds sterling]  0.759  3.628
Bloody amniotic fluid             0.564  4.820
Cesarean                          2.247  6.603
IUGR                              1.047  9.486
Turned cord                       1.405  4.670
NICU admission                    0.239  1.403
Fetus death                       0.088  4.228
Apgar<7                           1.278  3.911
PH<7.25                           0.404  2.911

Categorical variables according to Yes or No; [pounds sterling]
Determined subjectively;
IUGR: Intrauterine growth restriction; NICU: Neonatal intensive-care
unit
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Author:Akhavan, Setareh; Lak, Parvaneh; Rahimi-Sharbaf, Fatemeh; Mohammadi, Seyed Rahim; Shirazi, Mahboobeh
Publication:Iranian Journal of Medical Sciences
Article Type:Report
Date:Jul 1, 2017
Words:4536
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