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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, Joachim W.

Editorial Board Member: / Bancalari, Eduardo / Greenough, Anne / Genc, Mehmet R. / Chervenak, Frank A. / Chappelle, Joseph / Bergmann, Renate L. / Bernardes, J.F. / Bevilacqua, G. / Blickstein, Isaac / Cabero Roura, Luis / Carbonell-Estrany, Xavier / Carrera, Jose M. / D`Addario, Vincenzo / D'Alton, MD, Mary E. / Dimitrou, G. / Grunebaum, Amos / Hentschel, Roland / Köpcke, W. / Kawabata, Ichiro / Keirse, Marc J.N.C. / Kurjak M.D., Asim / Lee, Ben H. / Levene, Malcolm / Lockwood, Charles J. / Marsal, Karel / Makatsariya, Alexander / Nishida, Hiroshi / Ogata, Edward / Papp, Zoltán / Pejaver, Ranjan Kumar / Pooh, Ritsuko K. / Romero, Roberto / Saugstad, Ola D. / Schenker, Joseph G. / Sen, Cihat / Seri, Istvan / Vetter, Klaus / Winn, Hung N. / Young, Bruce K. / Zimmermann, Roland

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Neonatal neurological morbidity associated with uterine rupture

Miriam Martínez-Biarge1 / Alfredo García-Alix2 / Fátima García-Benasach3 / Francisco Gayá4 / Ana Alarcón5 / Antonio González6 / José Quero7

1Department of Pediatrics, Neonatology Division, La Paz University Hospital, Madrid, Spain

2Department of Pediatrics, Neonatology Division, La Paz University Hospital, Madrid, Spain

3Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain

4Biostatistics Unit, La Paz University Hospital, Madrid, Spain

5Department of Neonatology, Unitat Integrada Hospital Sant Joan de Deu-Hospital Clinic, Barcelona, Spain

6Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain

7Department of Pediatrics, Neonatology Division, La Paz University Hospital, Madrid, Spain

Corresponding author: Alfredo García-Alix, MD, PhD Department of Pediatrics, Neonatology Division La Paz University Hospital Paseo de la Castellana 261 28046 Madrid Spain Tel.: +34 917277416 Fax: +34 917277480

Citation Information: Journal of Perinatal Medicine. Volume 36, Issue 6, Pages 536–542, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: 10.1515/JPM.2008.078, August 2008

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Aims: To compare neonatal neurological morbidity associated with uterine rupture with morbidity associated with a non-reassuring fetal status.

Methods: We conducted a retrospective cohort analysis. Twenty-one cases of term infants delivered after a symptomatic uterine rupture were analyzed and compared with a randomly selected group of 63 infants born after a non-reassuring fetal heart rate pattern.

Results: Prevalence of uterine rupture was 0.058%. Maternal factors and infant general data were similar in both groups. Infants delivered after a uterine rupture had lower Apgar scores at 1 and 5 min, lower umbilical blood pH, and required more advanced resuscitation than infants delivered after a non-reassuring fetal status. Prevalence of hypoxic-ischemic encephalopathy in the uterine rupture group was 33%, compared with 5% in the other group (P<0.01, relative risk 3.7). Four infants in the uterine rupture group (19%) had moderate or severe encephalopathy; all of them had also multisystem dysfunction and an adverse outcome. No infant in the non-reassuring fetal status group showed moderate or severe encephalopathy.

Conclusions: Uterine rupture is a considerable sentinel event that involves a high rate of early and late neurological morbidity in the newborn infant.

Keywords: Neonatal hypoxic-ischemic encephalopathy; neurodevelopmental outcome; non-reassuring fetal status; perinatal brain injury; uterine rupture

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