Published: 2020-09-21

Evaluation of risk factors for perinatal asphyxia in a tertiary care hospital in Bangalore: an observational prospective study

Somashekhar Chikkanna, Kavya S., Saravanan P., Nagaraj M. V.


Background: Perinatal asphyxia is an insult to fetus or newborn due to lack of oxygen (hypoxia) or lack of perfusion (ischemia) to various organs of sufficient magnitude and duration. Prenatal asphyxia is one of the major causes of early neonatal mortality in India. Our goal was to evaluate risk factors of perinatal asphyxia.

Methods: Observational prospective study on 100 babies delivered in our hospital consecutively and requiring resuscitation were included.

Results: The mean age of mothers was 23.5 years. 54% neonates were born to primiparous mothers. Anaemia was widely prevalent in the mothers of neonates requiring resuscitation. The major maternal risk factors for newborns requiring resuscitation were pregnancy-induced hypertension (PIH) (46%), oligohydramnios (41%), polyhydramnios (30%) and meconium stained liquor (28%). The fetal factors associated with resuscitation of newborns were intrauterine growth restriction (IUGR) (30%), prematurity (25%), meconium aspiration syndrome (MAS) (20%), and neonatal seizures (36%). Mortality was highest in hypoxic ischemic encephalopathy (HIE) stage 3 with 11%.

Conclusions: The most common maternal risk factors for newborns requiring resuscitation was PIH followed by oligohydramnios, polyhydramnios and meconium stained liquor. IUGR was the most common fetal risk factor followed by, prematurity, MAS and neonatal seizures.


Perinatal asphyxia, Prematurity, Seizures, PIH, IUGR

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Lawn JE, Blencowe H, Oza S, You D, Lee AC, Waiswa P, et al. Every Newborn: progress, priorities, and potential beyond survival. Lancet. 2014;384:189-205.

Million Death Study Collaborators. Changes in cause-specific neonatal and 1-59-month child mortality in India from 2000 to 2015: a nationally representative survey. Lancet. 2017;390:1972-80.

Bryce J, Boschi-Pinto C, Shibuya K, Black RE. WHO estimates of the causes of death in children. Lancet. 2005;365(9465):1147-52.

UNICEF. The State of The World’s Children. 2008. Available at: Accessed on 22 April 2019.

Wyckoff MH, Aziz K, Escobedo MB, and Kapadia VS, Kattwinkel J, Perlman JM, et al. Part 13: Neonatal Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132:543-60.

Singh M. Paul VK, Deorani AK. Epidemiology correlates, early clinical features and sequelae of perinatal asphyxia. ICMR study report. 1992.

Bang AT, Bang RA, Baitule SB, Reddy HM, Deshmukh MD. Management of birth asphyxia in home deliveries in rural Gadchiroli: the effect of two types of birth attendants and of resuscitating with mouth-to-mouth, tube-mask or bag-mask. J Perinatol. 2005;25(1):82-91.

Ilah BG, Aminu MS, Musa A, Adelakun MB, Adeniji AO, Kolawole T. Prevalence and risk factors for perinatal asphyxia as seen at a specialist hospital in Gusau, Nigeria. Afr J Med. 2014;2:64-9.

Ellis M, Manandhar N, Manandhar DS, de L, Costello AM. Birth remains risky for infants in Kathmandu, Nepal, a developing country: unmatched case-control study. BMJ. 2000;320:1229-36.

Padayachee N, Ballot DE. Outcomes of neonates with perinatal asphyxia at a tertiary academic hospital in Johannesburg, South Africa. S Afr J CH. 2013;7:89-94.

Basu P, Som S, Das H, Choudhuri N. Electrolyte status in birth asphyxia. Indian J Pediatr. 2010;77(3):259-62.

Masood N, tulMuntiha S, Sharif M, Asghar RM. Correlation of serum electrolyte changes with severity of birth asphyxia in newborns. J Rawalpindi Med Col. 2014;20:27-9.

Etuk SJ, Etuk IS, Ekott MI, Udoma EJ. Perinatal outcome in pregnancies booked for ante-natal care but delivered outside health facilities in Calabar, Nigeria. Acta Trop. 2000;75:29-33.

Akhter S, Momen MA, Rahman MM, Parveen T, Karim RK. Effect of maternal anemia on fetal outcome. Mymensingh Med J. 2010;19(3):391-8.

Dalal CA, Bodar NL. A study on birth asphyxia at tertiary health centre. Natl J Med Res. 2013;3:374-6.

Lee AC, Mullany LC, Tielsch JM, Katz J, Khatry SK, LeClerq SC, Adhikari RK, Shrestha SR, Darmstadt GL. Risk factors for neonatal mortality due to birth asphyxia in southern Nepal: a prospective, community-based cohort study. Pediatrics. 2008;121(5):1381-90.

Nayeri F, Shariat M, Dalili H, Adam LB, Mehrjerdi FZ, Shakeri A. Perinatal risk factors for neonatal asphyxia in Vali-e-Asr hospital, Tehran-Iran. Iran J Reprod Med. 2012;10(2):137-40.

Onyearugha CN, Ugboma HA. Fetal outcome of antepartum and intrapartum eclampsia in Aba, southeastern Nigeria. Trop Dr. 2012;42(3):129-32.

Pitsawong C, Panichkul P. Risk factors associated with birth asphyxia in Phramongkutklao Hospital. Thai J Obstet Gynaecol. 2012;19(4):165-71.

Baker PN, Campbell S, Lees C. Obstetrics By Ten Teachers. 338 Euston road, London, NW1 3Bh: Hodder Arnold Publishers. 2006.

Majeed R, Memon Y, Majeed F, Shaikh NP, Rajar UD. Risk factors of birth asphyxia. J Ayub Med Coll Abbottabad. 2007;19(3):67-71.

Rachatapantanakorn O, Tongkumchum P, Chaisuksant Y. Factors associated with birth asphyxia in Pattani Hospital, Thailand. Songklanagarind Med J. 2010;23(1):17-27.