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(2020) 20:532

RESEARCH ARTICLE

Open Access

Intrapartum uterine activity and neonatal outcomes: a systematic review Adam J. Reynolds1* , Michael P. Geary2 and Breda C. Hayes1

Abstract Background: Increased uterine activity (UA) may not allow adequate recovery time for foetal oxygenation. Methods: The aim of the study was to determine if increased UA during labour is associated with an increased risk of either short- or long-term neurological injury in term neonates, or with neonatal proxy measures of intrapartum hypoxia-ischemia. MEDLINE, CINAHL, and ClinicalTrials.gov were searched using the following terms: uterine activity, excessive uterine activity, XSUA, uterine hyperstimulation, and tachysystole. Any study that analysed the relationship between UA during term labour and neurological outcomes/selected proxy neurological outcomes was eligible for inclusion. Outcomes from individual studies were reported in tables and presented descriptively with odds ratios (OR) and 95% confidence intervals (CI) for dichotomous outcomes and means with standard deviations for continuous outcomes. Where group numbers were provided, ORs and their CIs were calculated according to Altman. Main results: Twelve studies met the inclusion criteria. Seven studies featured umbilical artery pH as an individual outcome. Umbilical artery base excess and Apgar scores were both reported as individual outcomes in four studies. No study examined long term neurodevelopmental outcomes and only one study reported on encephalopathy as an outcome. The evidence for a relationship between UA and adverse infant outcomes was inconsistent. The reported estimated effect size varied from non-existent to clinically significant. Conclusions: There is some evidence that increased UA may be a non-specific predictor of depressed neurological function in the newborn, but it is inconsistent and insufficient to support the conclusion that an association generally exists. Keywords: Labour, Intrapartum, Fetal monitoring, Tachysystole, Uterine activity, Uterine contraction

Background The rationale for the proposed link between excessive uterine activity (UA) and fetal hypoxia is based on physiological studies of the haemodynamic changes that occur in the utero-placental and fetal circulations during a contraction. As a uterine contraction progresses, the amount of oxygenated blood delivered to the placenta decreases. Thus, the lowest fetal oxygen saturation percentage values are found towards the end of a * Correspondence: [email protected] 1 Department of Neonatology, The Rotunda Hospital, Dublin, Ireland Full list of author information is available at the end of the article

contraction and take some time to recover. Increased contraction frequencies may not allow adequate recovery time and may result in progressive reductions in fetal oxygen levels [1–3]. There is evidence that tocolytic medications may improve fetal heart rate (FHR) abnormalities when used while emergency delivery is pending [4]. Compared to emergent delivery, tocolysis for fetal dis