{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T02:42:14Z","timestamp":1789008134049,"version":"build-2803163510"},"reference-count":30,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2018,8,2]],"date-time":"2018-08-02T00:00:00Z","timestamp":1533168000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100010342","name":"Gillbergska stiftelsen","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010342","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004359","name":"Vetenskapsr\u00e5det","doi-asserted-by":"publisher","award":["2014\u20103561"],"award-info":[{"award-number":["2014\u20103561"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004359","name":"Vetenskapsr\u00e5det","doi-asserted-by":"publisher","award":["2012\u201000087"],"award-info":[{"award-number":["2012\u201000087"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004041","name":"Perinatal Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004041","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Our aim was to investigate the risk of moderate to severe hypoxic ischemic encephalopathy (<jats:styled-content style=\"fixed-case\">HIE<\/jats:styled-content>) by obstetric emergencies, with focus on the distribution of obstetric emergencies by parity, taking the history of a previous cesarean into account.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>Population\u2010based cohort study of 692\u00a0428 live births at \u2265\u00a036\u00a0weeks of gestation in Sweden, 2009\u20102015. Data were retrieved by linking the Swedish Medical Birth Register with the Swedish Neonatal Quality Register. Therapeutic hypothermia served as surrogate for moderate to severe <jats:styled-content style=\"fixed-case\">HIE<\/jats:styled-content>. Logistic regression analysis was used to estimate associations between <jats:styled-content style=\"fixed-case\">HIE<\/jats:styled-content> and placental abruption, eclampsia, cord prolapse, uterine rupture, and shoulder dystocia, presented as adjusted odds ratios (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>s) with 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>An obstetric emergency occurred in 133\/464 (29%) of all <jats:styled-content style=\"fixed-case\">HIE<\/jats:styled-content> cases, more commonly in the parous (overall 37%; 48% with and 31% without a previous cesarean) than in the nulliparous (21%). Among nulliparas, shoulder dystocia was the most common obstetric emergency with the strongest association with <jats:styled-content style=\"fixed-case\">HIE<\/jats:styled-content> (a<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 48.2; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 28.2\u201082.6). In parous women without a previous cesarean, shoulder dystocia was most common, but placental abruption had the strongest association with <jats:styled-content style=\"fixed-case\">HIE<\/jats:styled-content>. Among parous women with a previous cesarean, uterine rupture was the most prevalent obstetric emergency with the strongest association with <jats:styled-content style=\"fixed-case\">HIE<\/jats:styled-content> (a<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 45.6; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 24.5\u201084.6).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Obstetric emergencies are common among cases of moderate to severe <jats:styled-content style=\"fixed-case\">HIE<\/jats:styled-content>. The strong association with shoulder dystocia in nullipara, and with uterine rupture in women with previous cesarean deliveries, implies an opportunity for reducing the incidence of <jats:styled-content style=\"fixed-case\">HIE<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.13423","type":"journal-article","created":{"date-parts":[[2018,7,6]],"date-time":"2018-07-06T07:21:35Z","timestamp":1530861695000},"page":"1396-1404","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Obstetric emergencies as antecedents to neonatal hypoxic ischemic encephalopathy, does parity matter?"],"prefix":"10.1111","volume":"97","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0424-8807","authenticated-orcid":false,"given":"Lena","family":"Liljestrom","sequence":"first","affiliation":[{"name":"Department of Women's and Children's Health Uppsala University  Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna\u2010Karin","family":"Wikstrom","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health Uppsala University  Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Jonsson","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health Uppsala University  Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,8,2]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2010.05.010"},{"key":"e_1_2_9_3_1","first-page":"CD003311","article-title":"Cooling for newborns with hypoxic ischaemic encephalopathy","volume":"1","author":"Jacobs SE","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)17946-X"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2011-301524"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2007-0770"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpediatrics.2011.43"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-0511"},{"issue":"148","key":"e_1_2_9_9_1","first-page":"e141","article-title":"Perinatal morbidity and risk of hypoxic\u2010ischemic encephalopathy associated with intrapartum sentinel events","volume":"206","author":"Martinez\u2010Biarge M","year":"2012","journal-title":"Am J Obstet Gynecol"},{"issue":"667","key":"e_1_2_9_10_1","first-page":"e661","article-title":"Neonatal encephalopathy and the association to asphyxia in labor","volume":"211","author":"Jonsson M","year":"2014","journal-title":"Am J Obstet Gynecol"},{"issue":"155","key":"e_1_2_9_11_1","first-page":"e151","article-title":"Obstetric antecedents to body\u2010cooling treatment of the newborn infant","volume":"211","author":"Nelson DB","year":"2014","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2017.1321628"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.317.7172.1554"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.320.7244.1229"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2015.10.013"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2004.06.010"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.09.007"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2007.01484.x"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-009-9350-y"},{"key":"e_1_2_9_20_1","unstructured":"K\u00e4llenB K\u00e4llenK OlaussonPO.The Swedish Medical Birth Register: a summary of content and quality. 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