Obstetric antecedents to apparent stillbirth (Apgar score zero at 1 minuteonly)

Objective: To identify antecedent risk factors for the delivery of an infan t with an Apgar score of 0 at 1 minute who is subsequently successfully res uscitated. Methods: Infants born between January 1986 and February 1999 with 1-minute Apgar score of 0 followed by 5-minute Apgar score above 0 were studied. Eac h eligible infant was randomly matched with two control infants, born in th e same year, with 1-minute Apgar score greater than 0. Hospital records of their mothers were reviewed. The variables were compared between the groups by univariate analysis. Those factors demonstrating significant difference s were then analyzed by logistic regression. P <.05 was considered statisti cally significant. Results: Seventy-four of 81,603 infants (0.9:1000 births) born with an Apga r score of 0 at 1 minute only were compared with 148 control babies. Univar iate analysis revealed significant differences between study and control gr oup regarding: gestational age, abruptio placentae, preterm premature ruptu re of membranes, chorioamnionitis, preeclampsia, small-for-gestational age, male gender, bradycardia, and abnormal fetal heart rate (FHR) other than b radycardia, respectively. Logistic regression of these factors found gestat ional age, bradycardia, and abnormal FHR to be independent risk factors for the delivery of an apparent stillborn infant. After exclusion of FHR crite ria, logistic regression found gestational age (odds ratio [OR] 0.8 per wee k), male gender (OR 2.5), preeclampsia (OR 3.9), and abruptio placentae (OR 13.6) to be independent risk factors for the delivery of an apparent still born infant. Conclusion: Preterm birth, male gender, preeclampsia, and abruptio placenta e are independently associated with an increased risk of apparent stillbirt h. (Obstet Gynecol 2001; 97:961-4. (C) 2001 by The American College of Obst etricians and Gynecologists.).