Prediction of Neonatal Metabolic Acidosis in Women with a Singleton Term Pregnancy in Cephalic Presentation

Michelle E. M. H. Westerhuis, Ewoud Schuit*, Anneke Kwee, Nicolaas P. A. Zuithoff, Rolf H. H. Groenwold, Eline S. A. Van den Akker, Erik van Beek, Hendrikus J. H. M. Van Dessel, Addy P. Drogtrop, Herman P. Van Geijn, Guiseppe C. M. Graziosi, Jan M. M. van Lith, Jan G. Nijhuis, S. Guid Oei, Herman P. Oosterbaan, Martina Porath, Robert J. P. Rijnders, Nico W. E. Schuitemaker, Lia D. E. Wijnberger, Christine WillekesMaurice G. A. J. Wouters, Gerard H. A. Visser, Ben Willem J. Mol, Karel G. M. Moons

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

12 Citations (Web of Science)


We sought to predict neonatal metabolic acidosis at birth using antepartum obstetric characteristics (model 1) and additional characteristics available during labor (model 2). In 5667 laboring women from a multicenter randomized trial that had a high-risk singleton pregnancy in cephalic presentation beyond 36 weeks of gestation, we predicted neonatal metabolic acidosis. Based on literature and clinical reasoning, we selected both antepartum characteristics and characteristics that became available during labor. After univariable analyses, the predictors of the multivariable models were identified by backward stepwise selection in a logistic regression analysis. Model performance was assessed by discrimination and calibration. To correct for potential overfitting, we (internally) validated the models with bootstrapping techniques. Of 5667 neonates born alive, 107 (1.9%) had metabolic acidosis. Antepartum predictors of metabolic acidosis were gestational age, nulliparity, previous cesarean delivery, and maternal diabetes. Additional intrapartum predictors were spontaneous onset of labor and meconium-stained amniotic fluid. Calibration and discrimination were acceptable for both models (c-statistic 0.64 and 0.66, respectively). In women with a high-risk singleton term pregnancy in cephalic presentation, we identified antepartum and intrapartum factors that predict neonatal metabolic acidosis at birth.
Original languageEnglish
Pages (from-to)167-173
JournalAmerican Journal of Perinatology
Issue number3
Publication statusPublished - Mar 2012


  • antepartum risk factors
  • intrapartum risk factors
  • neonatal metabolic acidosis
  • prediction model

Cite this