NEONATAL NEUROLOGICAL OUTCOME AFTER LOW-RISK PREGNANCIES

Objectives: To study neonatal neurological outcome and obstetrical interventions in a low-risk population. Study design: A prospective non-randomised study. Setting: Six midwife practices, nine general practices in and around the city of Nijmegen, The Netherlands, and the obstetrical service at the Nijmegen University Hospital. Subjects: 766 midwife/general practitioner deliveries and 268 deliveries guided by obstetricians using electronic fetal monitoring, all after low risk pregnancy (one out of three selected), 49.2% of the women delivered at home. Methods: Neurological examination of the fullterm newborn infant according to Prechtl (1977). Results: The deliveries directed by the obstetricians showed higher complication and intervention rates for primiparae and multiparae. Primiparous deliveries involved longer labor and firstborns showed lower neurological outcome. There were no differences in neonatal neurological outcome between groups attended by midwives, general practitioners or obstetricians despite the lower social profile of the hospital group. Conclusion: For the outcome of low-risk pregnancy, the place of birth in the Nijmegen area is irrelevant. Further investigations on the physiology of the first pregnancy and on the causes of the higher complication and intervention rates in hospital deliveries are recommended.