Preventing The Human Factor: Organisational Aspects Linked to Foetal Asphyxia.

Abstract Background: the aim of this study was to identify prepartum, intrapartum and organisational risk factors for foetal asphyxia. We focused on modifiable factors such as organisational factors, maternal Body Mass Index, Assisted Reproductive Technology pregnancies, smoking and number of clinical checks.Methods: This is a retrospective analytical observational study.It was carried out in a teaching hospital in Northern Italy. The data for this study was obtained from maternal and neonatal medical records,obstetric and neonatal hospital discharge summaries and birth assistance certificates.162 cases of mothers whose children experienced foetal asphyxia were compared to 162 controls where this condition did not occur. The different variables were analysed using the Fisher test, the Mann Whitney U test and logistic regression. The association probability was estimated by the odds ratio with a confidence interval of 95%. The alpha level of 0,05 was considered significant.Results: giving birth at night (p<0.001), lack of one to one assistance during labour (p <0.001), birth on a day of high volume activity(p<0.001), Assisted Reproductive Technology obtained pregnancies (p<0.001), number of clinical checks during pregnancy (p <0.001 ), smoking during pregnancy (p<0.001), high maternal body mass index (p<0.001 ), as well as other traditionally associated risk factors like shoulder distocia (p35 (p <0.001) all increased the risk in a statistically significant way.Conclusions: giving birth on a high activity day, at night or without one-to one care are organisational factors that statistically increase the risk of foetal asphxia.Our paper proposes strategies to try and modify these risk factors and therefore limit the incidence of foetal asphyxia and of its life changing consequences like cerebral palsy.