Correlation between maternal haemoglobin and Bishop score at admission, duration of active phase of labour, Apgar score and neonatal birth weight in normal vaginal delivery: a hospital-based observational cross-sectional study
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20261627Keywords:
Maternal anaemia, Haemoglobin, Bishop score, Active phase of labour, Apgar score, Birth weight, NICU admission, PregnancyAbstract
Background: Maternal anaemia is one of the most prevalent nutritional disorders complicating pregnancy, particularly in low- and middle-income countries. It is associated with adverse maternal and neonatal outcomes; however, its influence on intrapartum parameters such as Bishop score and duration of active phase of labour remains inadequately explored.
Methods: A hospital-based observational cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, from May 2025 to April 2026. A total of 200 eligible term pregnant women undergoing normal vaginal delivery were enrolled. Maternal haemoglobin was measured at admission using an automated haematology analyser. Bishop score, duration of active phase of labour, Apgar scores at 1 and 5 minutes, and neonatal birth weight were recorded. Data were analysed using Chi-square test and ANOVA.
Results: No statistically significant association was found between maternal haemoglobin levels and Bishop score (p=0.56) or duration of active phase of labour (p=0.38). Although lower Apgar scores at 1 minute were more frequent among severely anaemic mothers (53.85%), this did not reach statistical significance (p=0.06), and 5-minute scores showed no significant difference (p=0.41). A highly significant association was observed between maternal haemoglobin and neonatal birth weight (p<0.0001), with 88% of severely anaemic mothers delivering low birth weight (LBW) neonates. NICU admission rates were also significantly higher in anaemic mothers (p=0.004). An inverse relationship between Bishop score and labour duration was also demonstrated (p=0.01).
Conclusions: Maternal haemoglobin levels do not significantly influence Bishop score or the duration of the active phase of labour but have a strong and significant impact on neonatal birth weight and NICU admission rates. Early detection, prevention, and effective management of maternal anaemia during antenatal care are essential to improve neonatal outcomes.
References
Safithri SF, Kania N, Diana A. Correlation between maternal haemoglobin level and birth weight. Althea Med J. 2019;6(2):78-82.
Dhole D, Kolhe S, Saxena A, Sharif M, Hedaginal VP. A prospective observational study of the effect of severity of maternal anaemia on the neonatal outcome. Indian J Neonatal Med Res. 2022;10(2):PO01-6.
WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva: WHO; 2011.
Anjanappa B, Bh R, Hg N, Ramaiah R, P S. A study of maternal anaemia and its association with perinatal outcome. Int J Reprod Contracept Obstet Gynecol. 2015;4(6):1806-9.
Drukker L, Hants Y, Farkash R, Ruchlemer R, Samueloff A. Iron deficiency anemia at admission for labor and delivery is associated with an increased risk for cesarean section and adverse maternal and neonatal outcomes. Transfusion. 2015;55(12):2799-806.
Young MF, Oaks BM, Rogers HP, Tandon S, Martorell R, Dewey KG, et al. Maternal low and high hemoglobin concentrations and associations with adverse maternal and infant health outcomes: an updated global systematic review and meta-analysis. BMC Pregnancy Childbirth. 2023;23(1):264.
Bishop EH. Pelvic scoring for elective induction. Obstet Gynecol. 1964;24:266-8.
Antrini KR, Wulandari IA, Ariani NKS, Santi LKS. Hubungan kadar haemoglobin dan paritas dengan lama persalinan kala II. WombMid J. 2025;4(1):1-8.
Sajjad M, Shakeel A, Kanwal S, Sabir A, Nadeem M. Maternal anemia as an independent risk factor for postpartum hemorrhage: a retrospective analysis. Cureus. 2025;17(1):75234.
Paramahamsa RRK, Kumari KS, Murthy NS. Maternal hemoglobin level and its association with neonatal outcome. Int J Contemp Med Res. 2019;6(5):E1-4.
Sharma I, Sharma P, Meena R. Effect of maternal haemoglobin on neonatal birth weight and Apgar score: a cross-sectional observational study. Int J Reprod Contracept Obstet Gynecol. 2025;14(2):456-61.
Farooq MH, Rizwan A, Mughal IA, Rizvi SHR, Faruqi A, Irfan A. Association of maternal age and hemoglobin level with Apgar score of newborns in a tertiary care hospital. JRMC. 2023;27(3). Available at: https://www.journalrmc.com/index.php/JRMC/article/view/2329. Accessed on 15 January 2026.
Sekhavat L, Davar R, Hosseinidezoki S. Relationship between maternal hemoglobin concentration and neonatal birth weight. Hematology. 2011;16(6):373-6.
Khan H, Khan K, Shehzadi N, Riaz H. Correlation of maternal haemoglobin with birth weight: a hospital based study. J Islamabad Med Dent Coll. 2021;10(1):19-24.
Tiwari P, Patel KK, Sinha M, Mishra S. Association of maternal haemoglobin with birth weight of newborns in urban poor population. J Family Med Prim Care. 2021;10(1):194-9.
Xie G, Wang R, Zhang B, Sun L, Xiang W. Non-linear connections between maternal hemoglobin during the third trimester of pregnancy and birth weight outcomes in full-term newborns: estimating the breakpoints. Front Nutr. 2022;9:1031781.
Anjanappa B, Bh R, Hg N, Ramaiah R. A study of maternal anaemia and its association with perinatal outcome. Int J Reprod Contracept Obstet Gynecol. 2015;4(6):1806-9.
Badi NEA, Almoula HA, Idris NIA, Hamadalnil Y, Handady SOM. Relationship of maternal haemoglobin concentration measured in labour with neonatal outcome among Sudanese women. Open J Obstet Gynecol. 2021;11(2):145-56.
Malhotra M, Sharma JB, Batra S, Sharma SD, Murthy NS. Maternal and perinatal outcome in varying degrees of anaemia. Int J Gynaecol Obstet. 2002;79(2):93-100.
Alizadeh L, Akbarzade M, Ramzi M, Zare N. The correlation between infants' birth weight and Apgar score and maternal haemoglobin concentration. Iran J Blood Cancer. 2014;7(1):17-21.
Azargoun AR, Dabaghi G. Correlation between maternal haemoglobin and placental weight. J Fam Reprod Health. 2006;1(1):41-5.
Cozzi GD, Levine LD, Durnwald CP. Predelivery anaemia and postpartum blood transfusion. Am J Obstet Gynecol MFM. 2023;5(2):100806.
Singh S, Rathoria E, Srivastava M, Rathoria R, Bansal U. Impact of maternal anaemia on neonatal outcomes. Int J Contemp Pediatr. 2024;11(1):1-6.
Das D, Das RK, Singnarpi E, Dutta S. Maternal anaemia in various trimesters of singleton pregnancies and its correlation with birth weight: an observational study. Natl J Physiol Pharm Pharmacol. 2022;13(1):1-5.
Eissa F, Elkhieder F, Awad S, Mukhtar E, Ahmed R. The correlation between maternal haemoglobin level and neonatal birth weight. Int J Multidiscip Curr Res. 2017;5:564-8.
Yıldız Y, Özgü E, Unlu SB, Salman B, Yapar Eyi EG. The relationship between third trimester maternal haemoglobin and birth weight/length; results from the tertiary centre in Turkey. J Matern Foetal Neonatal Med. 2014;27(7):729-32.
Asaf M, Ilyas M, Qasim T, Irfan S, Shoaib A. Maternal haemoglobin and its relationship with foetal birth weight. Pak J Med Health Sci. 2022;16(8):148-50.
Sah SK, Sunuwar DR, Baral JR, Singh DR, Chaudhary NK, Gurung G. Maternal haemoglobin and risk of low birth weight: a hospital-based cross-sectional study in Nepal. Heliyon. 2022;8(12):e12174.
Javadi M, Zarei S, Shiri-Shahsavar MR, Jafarimanesh H, Tola HH, Ranjbaran M. Association between maternal haemoglobin, other maternal attributes and neonatal birth weight: a case-control study. Curr Pediatr Rev. 2023;19(3):312-7.
Liu D, Li S, Zhang B, Kang Y, Cheng Y, Zeng L, et al. Maternal haemoglobin concentrations and birth weight, low birth weight, and small for gestational age. Nutrients. 2022;14(4):858.
Downloads
Published
How to Cite
Issue
Section
