Preventing the human factor: organizational aspects linked to fetal asphyxia.

BACKGROUND: Perinatal asphyxia can cause cerebral palsy and hypoxic-ischemic encephalopathy. They are public health problems because they cause permanent disability. METHODS: This is a retrospective, analytical, observational study. Overall, 162 cases of mothers whose children experienced fetal asphyxia were compared to 361 controls where this condition did not occur. The variables analyzed were classified as: prepartum, intrapartum and organizational. RESULTS: Assisted reproductive technology obtained pregnancies, smoking, maternal body mass index, lack of one-to-one assistance during labor, birth on a day of high-volume activity increased the risk of fetal asphyxia, as well as other traditionally linked factors like shoulder dystocia or age over 35 years. CONCLUSIONS: Cerebral palsy cannot always be prevented because it is a syndrome with a multitude of potential causes. But a small number of cases is likely to be linked to acute intrapartum events that could be limited by changing organizational policies such as staff training and implementing teamwork and discussion. Our paper proposes strategies to try and modify organizational risk factors and therefore limit the incidence of fetal asphyxia.

What may happen if you are pregnant during COVID-19 lockdown? A retrospective study about peripartum outcomes.

BACKGROUND: One of the provisions implemented to contain the spread of COVID-19 infections in Italy was the lockdown. Effects of the lockdown on childbirth outcomes and on the well-being of both the mother and the child have not yet been defined. An inadequate diet during pregnancy and a reduced physical activity can predispose women to become overweight or obese and trigger the development of various complications and maternal-fetal adverse outcomes. METHODS: This is a retrospective study including all consecutive patients who delivered at the Maggiore della Carità Hospital in Novara, Italy, in April-May 2017 (group 1, N.=294), a period prior to the pandemic, and during the same months in 2020 (group 2, N.=256) during and immediately after lockdown. Clinical data were extracted from the report "Childbirth Assistance Certificate (CedAP) - Birth Event Analysis." RESULTS: Demographic characteristics were similar between the two study groups, except for a decreased number of married couples in group 2 (P=0.018) and an increased percentage of patients with clinical checkups at family planning facilities in 2020 (P=0.04). The number of hospitalizations during pregnancy was 26 (8.9%) vs. 10 (3.9%) with a significative reduction during 2020 (P=0.004). Regarding obstetric outcomes, we observed a significant increase in induction of labour in 2020 (23.9% vs. 35.9%; P=0. 002), a reduction of amniorrhexis (11.3% vs. 5.5% P=0.015), a reduction of supine positions with an increase of vertical and all four positions in 2020 (49.3% vs. 61.9% and 9.5% vs. 12.4% respectively, P=0.023), and a reduction of left occipito-anterior presented part (63.2% vs. 55.4%) in favor of right occipito-anterior (34.7% vs. 41.2%, P=0.019). CONCLUSIONS: There were no significant differences either for antepartum or intrapartum complications. Long-term studies are needed to evaluate psychological, behavioral, and epigenetic effects of maternal physical inactivity on obstetric outcomes.