Catastrophic neonatal outcomes may change obstetricians’ risk evaluations
Obstetricians’ evaluation of risk may be altered by catastrophic neonatal outcomes, according to a recent study, which showed a transient increase in rates of unscheduled caesarean deliveries following hypoxic-ischaemic encephalopathy events resulting from obstetric mismanagement.
The research group conducted a retrospective chart review of all deliveries that occurred in a university hospital in Jerusalem, Israel, between 2009 and 2014. All cases of hypoxic-ischaemic encephalopathy that occurred in singleton, term, and liveborn neonates were noted, and rates of unscheduled caesarean deliveries performed before and after these events assessed.
A total of seven hypoxic-ischaemic encephalopathy events occurred during the study period, three of which were due to mismanaged deliveries. The baseline rate of unscheduled caesarean deliveries was found to be approximately 80 per 1,000 deliveries. However, in the first month following a mismanaged delivery, an additional 48 unscheduled caesarean deliveries (95 percent confidence interval [CI], 27–70 cases per 1,000) occurred. The researchers estimated that approximately 17 additional unscheduled caesarean deliveries were performed for every mismanaged delivery (95 percent CI, 8–27 cases per 1,000). The effect was transient and no such increase was evident following hypoxic-ischaemic encephalopathy events that were not related to obstetric mismanagement.
The researchers suggested that their findings may increase physician awareness of such interactions and thereby promote more uniform medical decision-making.