NEONATAL NEUROLOGICAL OUTCOME AFTER LOW-RISK PREGNANCIES

Objectives: To study neonatal neurological outcome and obstetrical int erventions in a low-risk population. Study design: A prospective non-r andomised study. Setting: Six midwife practices, nine general practice s in and around the city of Nijmegen, The Netherlands, and the obstetr ical service at the Nijmegen University Hospital. Subjects: 766 midwif e/general practitioner deliveries and 268 deliveries guided by obstetr icians using electronic fetal monitoring, all after low risk pregnancy (one out of three selected), 49.2% of the women delivered at home. Me thods: Neurological examination of the fullterm newborn infant accordi ng to Prechtl (1977). Results: The deliveries directed by the obstetri cians showed higher complication and intervention rates for primiparae and multiparae. Primiparous deliveries involved longer labor and firs tborns showed lower neurological outcome. There were no differences in neonatal neurological outcome between groups attended by midwives, ge neral practitioners or obstetricians despite the lower social profile of the hospital group. Conclusion: For the outcome of low-risk pregnan cy, the place of birth in the Nijmegen area is irrelevant. Further inv estigations on the physiology of the first pregnancy and on the causes of the higher complication and intervention rates in hospital deliver ies are recommended.