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Shemesh R, Strauss T, Zaslavsky-Paltiel I, Lerner-Geva L, Reichman B, Wygnanski-Jaffe T. Perinatal and neonatal risk factors for retinopathy of prematurity in very low birthweight, very preterm twins: a population-based study. Eye (Lond) 2024; 38:902-909. [PMID: 37925560 PMCID: PMC10965998 DOI: 10.1038/s41433-023-02801-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 09/28/2023] [Accepted: 10/17/2023] [Indexed: 11/06/2023] Open
Abstract
OBJECTIVE To determine the effect of perinatal and neonatal risk factors on retinopathy of prematurity (ROP) and to examine the association of fertility treatments on the risk for ROP in very low birth weight (VLBW) preterm twins. METHODS The population-based observational study consisted of VLBW twins born at 24-29 weeks gestational age (GA). Data from the Israel national database (1995-2020) were applied. Univariate and multivariable logistic regression using the General Estimating Equation were used for assessment of risk factors. RESULTS The study population comprised 4092 infants of whom 2374 (58%) were conceived following fertility treatments. ROP was diagnosed in 851 (20.8%) infants. The odds for ROP approximately doubled with each week decrease in GA: at 24 weeks, Odds Ratio (OR) 58.00 (95% confidence interval (CI) 31.83-105.68); 25 weeks, OR 25.88 (95% CI 16.76-39.96); 26 weeks, OR 12.69 (95% CI 8.84-18.22) compared to 29 weeks GA. Each decrease in one birthweight z-score was associated with 1.82-fold increased risk for ROP (OR, 1.82, 95% CI 1.59-2.08). Infertility treatments were not associated with ROP. Neonatal morbidities significantly associated with ROP were surgical necrotizing enterocolitis (NEC) (OR, 2.04, 95% CI 1.31-3.19); surgically treated patent ductus arteriosus (PDA) (OR, 1.63, 95% CI 1.12-2.37); sepsis (OR, 1.43, 95% CI 1.20-1.71) and bronchopulmonary dysplasia (OR, 1.52, 95% CI 1.22-1.90). CONCLUSION Among preterm VLBW twins, poor intrauterine growth and surgical interventions for NEC and PDA were associated with high odds for ROP. This study does not support an association of fertility treatments with increased risk for ROP.
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Affiliation(s)
- Rachel Shemesh
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Tzipi Strauss
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Neonatology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Inna Zaslavsky-Paltiel
- Women and Children's Health Research Unit, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Liat Lerner-Geva
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Women and Children's Health Research Unit, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Brian Reichman
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Women and Children's Health Research Unit, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Tamara Wygnanski-Jaffe
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.
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Demertzidou E, Chatzakis C, Cavoretto P, Sarafidis K, Eleftheriades M, Gerede A, Dinas K, Sotiriadis A. Effect of mode of delivery on perinatal outcome in severe preterm birth: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:471-485. [PMID: 37128165 DOI: 10.1002/uog.26241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To review the evidence on the effect of mode of delivery on perinatal outcome of fetuses born before 32 weeks' gestation. METHODS MEDLINE, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), the ClinicalTrials.gov registry and gray literature sources were searched, starting from the year 2000 to reflect contemporary practice in perinatal care. Non-randomized or randomized studies that included singleton fetuses without chromosomal abnormality or major congenital defect delivered vaginally or via Cesarean section were eligible for inclusion in the analysis. Primary outcomes were neonatal death, defined as death in the first 28 days of age, and survival to discharge. Secondary outcomes were other adverse perinatal events. The ROBINS-I tool was used to assess the risk of bias. The overall quality of evidence for the outcomes was assessed according to GRADE. Summary odds ratios (ORs) with 95% CIs were calculated, and random-effects models were used for data synthesis. Subgroup analysis was performed for delivery before 28 weeks, delivery between 28 and 32 weeks and according to fetal presentation at delivery. RESULTS A total of 27 retrospective studies (22 887 neonates) were included in the systematic review and meta-analysis, all of which reported on singleton pregnancies. Among cases born before 28 weeks, vaginal delivery significantly increased the risk of neonatal death of fetuses with any type of presentation (n = 1496) (OR 1.87 (95% CI, 1.05-3.35); I2 = 65%, very low quality of evidence) and of fetuses with breech presentation (n = 733) (OR 3.55 (95% CI, 2.42-5.21); I2 = 21%, moderate quality of evidence). The odds of survival to discharge were significantly decreased among fetuses with breech presentation delivered before 28 weeks (n = 646) (OR 0.36 (95% CI, 0.24-0.54); I2 = 21%, low quality of evidence). Among breech fetuses born between 28 and 32 weeks, vaginal delivery increased the odds of perinatal death (intrapartum and neonatal) (n = 1581) (OR 3.06 (95% CI, 1.47-6.35); I2 = 0%, high quality of evidence). In non-cephalic fetuses born between 24 and 32 weeks, vaginal delivery decreased the odds of survival to discharge (n = 1030) (OR 0.28 (95% CI, 0.19-0.40); I2 = 0%, moderate quality of evidence). No significant effect on mortality of mode of delivery was observed in cephalic fetuses at any gestational age. CONCLUSIONS This systematic review and meta-analysis suggests that vaginal delivery in severe preterm birth is associated with an increased risk of neonatal and perinatal death in breech fetuses, while no significant association was observed for cephalic fetuses. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Demertzidou
- Second Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - C Chatzakis
- Second Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - P Cavoretto
- Department of Obstetrics and Gynecology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - K Sarafidis
- First Department of Neonatology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - M Eleftheriades
- Second Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A Gerede
- Department of Obstetrics and Gynecology, University of Thrace, Alexandroupolis, Greece
| | - K Dinas
- Second Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Golbasi C, Golbasi H, Bayraktar B, Omeroglu I, Vural T, Sahingoz Yildirim AG, Ekin A. Cesarean delivery rates based on time and indication using the Robson Ten-Group Classification System: Assessment at a Turkish tertiary center. J Obstet Gynaecol Res 2023; 49:883-892. [PMID: 36502809 DOI: 10.1111/jog.15522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study aimed to evaluate increasing cesarean delivery (CD) rates, their causes, and changes over the years in a Turkish tertiary center using the Robson Ten-Group Classification System (RTGCS). METHODS Data of deliveries involving birth weight of ≥500 g or ≥24 weeks of gestation period from 2013 to 2020 were retrospectively collected and classified from the hospital digital record system using obstetric concepts and parameters described in the RTGCS. RESULTS The overall CD rate for all births (69051) from 2013 to 2020 was 55.5%. Groups 3, 5, and 1 were the most represented groups (29.1%, 23.9%, and 19.4%, respectively). The major contributors to the overall CD rate were Groups 5, 2, and 10 (23.8%, 9.9%, and 5.6%, respectively). Groups 2 and 4 (nullipara, multipara, single cephalic at term) had high CD rates associated with high rates of pre-labor CD (88.9% and 73.3%, respectively). The CD rate was 99.7% in Group 5, which showed recurrent CD, and 67.2% in Group 10. The overall CD rate was 60.8% in 2020 owing to the significant increase in the contributions by Groups 5, 8, and 10. The most common indication for CD was previous CD (46.1%), fetal distress (13.2%), and cephalopelvic disproportion (CPD) (8%). CONCLUSION Groups 1, 2, 5, and 10 were the major contributors to the overall CD rate at this tertiary center. To reduce overall CD rates, policies that reduce primary CD and support vaginal delivery after cesarean section should be established.
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Affiliation(s)
- Ceren Golbasi
- Department of Obstetrics and Gynecology, Izmir Tinaztepe University Faculty of Medicine, Izmir, Turkey
| | - Hakan Golbasi
- Department of Obstetrics and Gynecology Division of Perinatology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Burak Bayraktar
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ibrahim Omeroglu
- Department of Obstetrics and Gynecology Division of Perinatology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Tayfun Vural
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Alkim Gulsah Sahingoz Yildirim
- Department of Obstetrics and Gynecology Division of Perinatology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Atalay Ekin
- Department of Obstetrics and Gynecology Division of Perinatology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
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Karayel Eroglu H, Gulasi S, Mert MK, Cekinmez EK. Relationship between the mode of delivery, morbidity and mortality in preterm infants. J Trop Pediatr 2022; 68:6865123. [PMID: 36458965 DOI: 10.1093/tropej/fmac074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND The aim of the study, to evaluate the relationship between mode of delivery and preterm morbidities and mortality, who born ≤34 weeks of gestation within 1 year. MATERIALS AND METHODS Babies were divided into two groups as who were born by cesarean section (CS) and vaginal delivery (VD) between March 2019 and March 2020. Infants born at ≤28 weeks were also analyzed. RESULTS The rate of CS delivery was 76% (378) in the whole group and 73% (115) in the babies of ≤28 gestational weeks. The most common maternal factor causing CS was preeclampsia (25%). The antenatal corticosteroid (ACS) application rate was 30% (152) in the whole group and 30% (45) in infants of ≤28 weeks. Rate of babies with an Apgar score of <5 at 5th min, asphyxia, multiple organ failure, development of severe respiratory distress syndrome, severe intraventricular hemorrhage (IVH) and mortality were significantly increased in infants born VD (for all p < 0.05). Mortality was significantly higher when gestational age was ≤28 weeks, birth weight was ≤1500 g and ACS was not administered (p < 0.001 for all). CONCLUSION Mortality, severe IVH, neonatal asphyxia and multiple organ failure were found to be higher in those who were born by VD. These findings suggest that these results were due to inadequate prenatal care and follow-up and lack of ACS.
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Affiliation(s)
- Hulya Karayel Eroglu
- Department of Neonatology, Health Sciences University, Adana City Training and Research Hospital, Adana, Turkey
| | - Selvi Gulasi
- Department of Neonatology, Health Sciences University, Adana City Training and Research Hospital, Adana, Turkey
| | - M Kurthan Mert
- Department of Neonatology, Health Sciences University, Adana City Training and Research Hospital, Adana, Turkey
| | - Eren K Cekinmez
- Department of Neonatology, Health Sciences University, Adana City Training and Research Hospital, Adana, Turkey
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Cesarean section was not associated with mortality or morbidities advantage in very low birth weight infants: a nationwide cohort study. Sci Rep 2021; 11:20264. [PMID: 34642372 PMCID: PMC8511270 DOI: 10.1038/s41598-021-99563-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022] Open
Abstract
This study investigated the role of cesarean section (CS) in mortality and morbidity of very-low-birth-weight infants (VLBWIs) weighing less than 1500 g. This nationwide prospective cohort study of the Korean Neonatal Network consisted of 9,286 VLBWIs at 23–34 gestational weeks (GW) of age between 2013 and 2017. The VLBWIs were stratified into 23–24, 25–26, 27–28 and 29–34 GW, and the mortality and morbidity were compared according to the mode of delivery. The total CS rate was 78%, and was directly proportional to gestational age. The CS rate was the lowest at 61% in case of infants born at 23–24 GW and the highest at 84% in VLBWIs delivered at 29–34 GW. Contrary to the significantly lower total mortality (12%) and morbidities including sepsis (21%) associated with CS than vaginal delivery (VD) (16% and 24%, respectively), the mortality in the 25–26 GW (26%) and sepsis in the 27–28 GW (25%) and 29–34 GW (12%) groups were significantly higher in CS than in VD (21%, 20% and 8%, respectively). In multivariate analyses, the adjusted odds ratios (ORs) for mortality (OR 1.06, 95% CI 0.89–1.25) and morbidity including sepsis (OR 1.12, 95% CI 0.98–1.27) were not significantly reduced with CS compared with VD. The adjusted ORs for respiratory distress syndrome (1.89, 95% CI 1.59–2.23) and symptomatic patent ductus arteriosus (1.21, 95% CI 1.08–1.37) were significantly increased with CS than VD. In summary, CS was not associated with any survival or morbidity advantage in VLBWIs. These findings indicate that routine CS in VLBWIs without obstetric indications is contraindicated.
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Klinger G, Bromiker R, Zaslavsky-Paltiel I, Sokolover N, Lerner-Geva L, Yogev Y, Reichman B. Antepartum Hemorrhage and Outcome of Very Low Birth Weight, Very Preterm Infants: A Population-Based Study. Am J Perinatol 2021; 38:1134-1141. [PMID: 32446258 DOI: 10.1055/s-0040-1710353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We aimed to determine the independent effect of maternal antepartum hemorrhage (APH) on mortality and major neonatal morbidities among very low birth weight (VLBW), very preterm infants. STUDY DESIGN A population-based cohort study of VLBW singleton infants born at 24 to 31 weeks of gestation between 1995 and 2016 was performed. Infants born with the following pregnancy associated complications were excluded: maternal hypertensive disorders, prolonged rupture of membranes, amnionitis, maternal diabetes, and small for gestational age. APH included hemorrhage due to either placenta previa or placental abruption. Univariate and multivariable logistic regression analyses were performed to assess the effect of maternal APH on mortality and major neonatal morbidities. RESULTS The initial cohort included 33,627 VLBW infants. Following exclusions, the final study population comprised 6,235 infants of whom 2,006 (32.2%) were born following APH and 4,229 (67.8%) without APH. In the APH versus no APH group, there were higher rates of extreme prematurity (24-27 weeks of gestation; 51.6% vs. 45.3%, p < 0.0001), mortality (20.2 vs. 18.5%, p = 0.011), bronchopulmonary dysplasia (BPD, 16.1 vs. 13.0%, p = 0.004) and death or adverse neurologic outcome (37.4 vs. 34.5%, p = 0.03). In the multivariable analyses, APH was associated with significantly increased odds ratio (OR) for BPD in the extremely preterm infants (OR: 1.31, 95% confidence interval: 1.05-1.65). The OR's for mortality, adverse neurological outcomes, and death or adverse neurological outcome were not significantly increased in the APH group. CONCLUSION Among singleton, very preterm VLBW infants, maternal APH was associated with increased odds for BPD only in extremely premature infants, but was not associated with excess mortality or adverse neonatal neurological outcomes. KEY POINTS · Outcome of very low birth weight infants born after antepartum hemorrhage (APH) was assessed.. · APH was not associated with higher infant mortality.. · APH was not associated with adverse neurological outcome.. · APH was associated with increased bronchopulmonary dysplasia in extremely preterm infants..
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Affiliation(s)
- Gil Klinger
- Department of Neonatal Intensive Care, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Reuben Bromiker
- Department of Neonatal Intensive Care, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inna Zaslavsky-Paltiel
- Women and Children's Health Research Unit, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Nir Sokolover
- Department of Neonatal Intensive Care, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Lerner-Geva
- Women and Children's Health Research Unit, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Yogev
- Department of Neonatal Intensive Care, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Department of Obstetrics, Gynecology and Fertility, Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Brian Reichman
- Women and Children's Health Research Unit, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kayiga H, Achanda Genevive D, Amuge PM, Byamugisha J, Nakimuli A, Jones A. Incidence, associated risk factors, and the ideal mode of delivery following preterm labour between 24 to 28 weeks of gestation in a low resource setting. PLoS One 2021; 16:e0254801. [PMID: 34293031 PMCID: PMC8297859 DOI: 10.1371/journal.pone.0254801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/05/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Preterm labour, between 24 to 28 weeks of gestation, remains prevalent in low resource settings. There is evidence of improved survival after 24 weeks though the ideal mode of delivery remains unclear. There are no clear management protocols to guide patient management. We sought to determine the incidence of preterm labour occurring between 24 to 28 weeks, its associated risk factors and the preferred mode of delivery in a low resource setting with the aim of streamlining patient care. METHODS Between February 2020 and September 2020, we prospectively followed 392 women with preterm labour between 24 to 28 weeks of gestation and their newborns from admission to discharge at Kawempe National Referral hospital in Kampala, Uganda. The primary outcome was perinatal mortality associated with the different modes of delivery. Secondary outcomes included neonatal and maternal infections, admission to the Neonatal Special Care Unit (SCU), need for neonatal resuscitation, preterm birth and maternal death. Chi-square test was used to assess the association between perinatal mortality and categorical variables such as parity, mode of delivery, employment status, age, antepartum hemorrhage, digital vaginal examination, and admission to Special Care unit. Multivariate logistic regression was used to assess the association between comparative outcomes of the different modes of delivery and maternal and neonatal risk factors. RESULTS The incidence of preterm labour among women who delivered preterm babies between 24 to 28 weeks was 68.9% 95% CI 64.2-73.4). Preterm deliveries between 24 to 28 weeks contributed 20% of the all preterm deliveries and 2.5% of the total hospital deliveries. Preterm labour was independently associated with gravidity (p-value = 0.038), whether labour was medically induced (p-value <0.001), number of digital examinations (p-value <0.001), history of vaginal bleeding prior to onset of labour (p-value < 0.001), whether tocolytics were given (p-value < 0.001), whether an obstetric ultrasound scan was done (p-value <0.001 and number of babies carried (p-value < 0.001). At multivariate analysis; multiple pregnancy OR 15.45 (2.00-119.53), p-value < 0.001, presence of fever prior to admission OR 4.03 (95% CI .23-13.23), p-value = 0.002 and duration of drainage of liquor OR 0.16 (0.03-0.87), p-value = 0.034 were independently associated with preterm labour. The perinatal mortality rate in our study was 778 per 1000 live births. Of the 392 participants, 359 (91.5%), had vaginal delivery, 29 (7.3%) underwent Caesarean delivery and 4 (1%) had assisted vaginal delivery. Caesarean delivery was protective against perinatal mortality compared to vaginal delivery OR = 0.36, 95% CI 0.14-0.82, p-value = 0.017). The other protective factors included receiving antenatal corticosteroids OR = 0.57, 95% CI 0.33-0.98, p-value = 0.040, Doing 3-4 digital exams per day, OR = 0.41, 95% 0.18-0.91, p-value = 0.028) and hospital stay of > 7 days, p value = 0.001. Vaginal delivery was associated with maternal infections, postpartum hemorrhage, and admission to the Special Care Unit. CONCLUSION Caesarean delivery is the preferred mode of delivery for preterm deliveries between 24 to 28 weeks of gestation especially when labour is not established in low resource settings. It is associated with lesser adverse pregnancy outcomes when compared to vaginal delivery for remote gestation ages.
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Affiliation(s)
- Herbert Kayiga
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Josaphat Byamugisha
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Annettee Nakimuli
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Andrew Jones
- University of Manchester, Manchester, United Kingdom
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Kawakita T, Sondheimer T, Jelin A, Reddy UM, Landy HJ, Huang CC, Ramsey PS, Kominiarek MA, Grantz KL. Maternal morbidity by attempted route of delivery in periviable birth. J Matern Fetal Neonatal Med 2021; 34:1241-1248. [PMID: 31242781 PMCID: PMC6930981 DOI: 10.1080/14767058.2019.1631792] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 06/05/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Much of the literature on clinical decision-making regarding the optimal route of delivery for periviable birth, 23 0/7-25 6/7 weeks gestation, has focused on neonatal risks. In fact, routine cesarean delivery at these early gestational ages has not been shown to improve neonatal mortality or neurological outcomes. Neonatal risks associated with the route of delivery are well known. Conversely, there is a paucity of data on maternal morbidity associated with the route of delivery. We examined maternal morbidity according to the attempted route of delivery in women undergoing periviable birth. STUDY DESIGN In a secondary analysis of the Consortium on Safe Labor, a retrospective cohort study, maternal outcomes were compared between attempted vaginal delivery and planned cesarean delivery in women undergoing periviable birth. Analyses were repeated to compare maternal outcomes among actual mode of delivery (vaginal delivery versus cesarean delivery). Multivariable Poisson regression was used to estimate adjusted relative risks (aRR) with 95% confidence intervals (95% CI), controlling for predefined covariates. RESULTS Of 678 women who underwent periviable birth, 558 (82.3%) and 120 (17.7%) attempted vaginal delivery and planned cesarean delivery, respectively. Of 558 women who attempted a vaginal delivery, 411 (73.7%) achieved a vaginal delivery. Women who attempted a vaginal delivery compared to those who had a planned cesarean delivery were less likely to have endometritis (3.1 versus 15.0%; aRR 0.18, 95% CI 0.09-0.35). Women who attempted a vaginal delivery compared to those who had a planned cesarean delivery had 7-day shorter total length of hospital stay (p < .001). Comparison of actual mode of delivery showed that women with vaginal had decreased risks of fever (2.9 versus 7.9%; aRR 0.42, 95% CI 0.20-0.90), endometritis (0.5 versus 12.4%; aRR 0.03, 95% CI 0.01-0.13), and maternal thrombosis (0.2 versus 3.0%; aRR 0.08, 95% CI 0.01-0.93) compared to cesarean delivery. Women with vaginal delivery had 3-day shorter total length of hospital stay (p < .001) compared to cesarean delivery. CONCLUSION The majority of women (73.7%) who attempted a vaginal delivery achieved a vaginal delivery. Attempting a vaginal delivery between 23 0/7 and 25 6/7 weeks gestation compared to a planned cesarean delivery was associated with decreased risks of maternal infectious morbidity. Deciding the route of delivery is challenging in women undergoing periviable delivery. Our analysis provides important information on short-term maternal risks when considering the risks and benefits during these discussions.
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Affiliation(s)
- Tetsuya Kawakita
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington DC
| | - Tavor Sondheimer
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington DC
| | - Angie Jelin
- Department of Gynecology and Obstetrics, Johns Hopkins University Hospital, Baltimore, MD
| | - Uma M. Reddy
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington DC
| | - Helain J. Landy
- Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, DC
| | - Chun-Chih Huang
- Department of Biostatistics and Epidemiology, MedStar Health Research Institute, Hyattsville, MD
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, District of Columbia
| | - Patrick S. Ramsey
- Center for Pregnancy and Newborn Research, UT Health San Antonio, San Antonio, TX
| | | | - Katherine L. Grantz
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington DC
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Czarny HN, Forde B, DeFranco EA, Hall ES, Rossi RM. Association between mode of delivery and infant survival at 22 and 23 weeks of gestation. Am J Obstet Gynecol MFM 2021; 3:100340. [PMID: 33652159 DOI: 10.1016/j.ajogmf.2021.100340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cesarean delivery is currently not recommended before 23 weeks' gestation unless for maternal indications, even in the setting of malpresentation. These recommendations are based on a lack of evidence of improved neonatal outcomes and survival following cesarean delivery and the maternal risks associated with cesarean delivery at this early gestational age. However, as neonatal resuscitative measures and obstetrical interventions improve, studies evaluating the potential neonatal benefit of periviable cesarean delivery have reported inconsistent findings. OBJECTIVE This study aimed to compare the survival rates at 1 year of life among resuscitated infants delivered by cesarean delivery with those delivered vaginally at 22 and 23 weeks of gestation. STUDY DESIGN We conducted a population-based cohort study of all resuscitated livebirths delivered between 22 0/7 and 23 6/7 weeks of gestational age in the United States between 2007 and 2013. The primary outcome was the rate of infant survival at 1 year of life for different routes of delivery (cesarean vs vaginal delivery) at both 22 and 23 weeks of gestation. The secondary outcome variables included infant survival rates for neonates who survived beyond 24 hours of life, neonatal survival, and the length of survival. A secondary analysis also included a comparison of the infant survival rates between the different routes of delivery cohorts stratified by fetal presentation, steroid exposure, and ventilation. Information about composite adverse maternal outcomes were limited to infants who were delivered between 2011 and 2013 (when these items were first reported) and were defined as a requirement for blood transfusion, an unplanned operating room procedure following delivery, unplanned hysterectomy, and intensive care unit admission; the composite adverse maternal outcomes were also compared between the different delivery route cohorts for deliveries occurring between 22 and 23 weeks of gestation. Multivariable logistic regression analysis was used to determine the association between cesarean delivery and infant survival and other neonatal and maternal outcomes. RESULTS Resuscitated infants delivered by cesarean delivery had higher rates of survival at 22 weeks (44.9 vs 23.0%; P<.001) and at 23 weeks (53.3 vs 43.4%; P<.001) of gestation regardless of fetal presentation. Multivariable logistic regression analysis demonstrated that infants who were delivered by cesarean delivery at 22 weeks (adjusted relative risk, 2.3; 95% confidence interval, 1.9-2.8) and 23 weeks (adjusted relative risk, 1.4; 95% confidence interval, 1.2-1.5) of gestation were more likely to survive than those delivered vaginally. When the cohort was limited to neonates who survived beyond the first 24 hours of life, vertex neonates born by cesarean delivery were not more likely to survive at 22 weeks (adjusted relative risk, 1.2; 95% confidence interval, 0.9-1.7) or 23 weeks (adjusted relative risk, 1.1; 95% confidence interval, 0.9-1.3) of gestation. An increased risk for composite adverse maternal outcomes (adjusted relative risk, 1.7; 95% confidence interval, 1.1-2.7) was associated with cesarean delivery at 22 to 23 weeks of gestation. CONCLUSION Cesarean delivery is associated with increased survival at 1 year of life among resuscitated, periviable infants born between 22 0/7 and 23 6/7 weeks of gestation, especially in the setting of nonvertex presentation. However, cesarean delivery is associated with increased maternal morbidity.
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Affiliation(s)
- Heather N Czarny
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH (Drs Czarny, Forde, Rossi, and DeFranco);.
| | - Braxton Forde
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH (Drs Czarny, Forde, Rossi, and DeFranco)
| | - Emily A DeFranco
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH (Drs Czarny, Forde, Rossi, and DeFranco);; Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Drs DeFranco and Hall)
| | - Eric S Hall
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Drs DeFranco and Hall); Translational Data Science and Informatics, Geisinger, Danville, PA, USA (Dr Hall)
| | - Robert M Rossi
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH (Drs Czarny, Forde, Rossi, and DeFranco)
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10
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Morgan AS, Waheed S, Gajree S, Marlow N, David AL. Maternal and infant morbidity following birth before 27 weeks of gestation: a single centre study. Sci Rep 2021; 11:288. [PMID: 33431902 PMCID: PMC7801674 DOI: 10.1038/s41598-020-79445-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/30/2020] [Indexed: 11/09/2022] Open
Abstract
Delivery at extreme preterm gestational ages (GA) [Formula: see text] weeks is challenging with limited evidence often focused only on neonatal outcomes. We reviewed management and short term maternal, fetal and neonatal outcomes of births for 132 women (22 + 0 to 26 + 6 weeks' GA) with a live fetus at admission to hospital and in labour or at planned emergency Caesarean section: 103 singleton and 29 (53 live fetuses) twin gestations. Thirty women (23%) had pre-existing medical problems, 110 (83%) had antenatal complications; only 17 (13%) women experienced neither. Major maternal labour and delivery complications affected 35 women (27%). 151 fetuses (97%) were exposed to antenatal steroids, 24 (15%) to tocolysis and 70 (45%) to magnesium sulphate. Delivery complications affected 11 fetuses, with 12 labour or delivery room deaths; survival to discharge was 75% (117/156), increasing with GA: 25% (1/4), 75% (18/24), 69% (29/42), 73% (33/45) and 88% (36/41) at 22, 23, 24, 25 and 26 weeks GA respectively (p = 0.024). No statistically important impact was seen from twin status, maternal illness or obstetric management. Even in a specialist perinatal unit antenatal and postnatal maternal complications are common in extreme preterm births, emphasising the need to include maternal as well as neonatal outcomes.
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Affiliation(s)
- Andrei S Morgan
- Research Department of Neonatology, Elizabeth Garrett Anderson Institute for Women's Health, University College London, 2nd floor, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK.,INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Hôpital Tenon, Rue de la Chine, 75020, Paris, France.,SAMU 93-SMUR Pédiatrique, CHI André Gregoire, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, Assistance Publique des Hôpitaux de Paris, Montreuil, France.,Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Saadia Waheed
- Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Shivani Gajree
- Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Neil Marlow
- Research Department of Neonatology, Elizabeth Garrett Anderson Institute for Women's Health, University College London, 2nd floor, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK.,Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK.,NIHR University College London Hospitals BRC, Maple House, 149 Tottenham Court Road, London, W1T 7DN, UK
| | - Anna L David
- Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK. .,NIHR University College London Hospitals BRC, Maple House, 149 Tottenham Court Road, London, W1T 7DN, UK. .,Research Department of Maternal Fetal Medicine, Institute for Women's Health, University College London, 2nd floor, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK.
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11
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Lodha A, Ediger K, Creighton D, Tang S, Lodha A, Wood S. Caesarean section and neonatal survival and neurodevelopmental impairments in preterm singleton neonates. Paediatr Child Health 2021; 25:93-101. [PMID: 33390746 DOI: 10.1093/pch/pxz051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 03/14/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction Evidence is lacking regarding the benefit of caesarean section (CS) for long-term neurodevelopmental outcomes in singleton preterm neonates. Therefore, uncertainty remains regarding obstetrical best practice in the delivery of premature neonates. Objective Our objective was to determine the association between the mode of delivery and neurodevelopmental outcomes in preterm singleton neonates who were delivered by vaginal route (VR), CS with labour (CS-L), or CS without labour (CS-NL). Methods Singleton neonates of less than 29 weeks' gestation born January 1995 through December 2010 and admitted to our NICU and then assessed at neonatal follow-up clinic were studied. The primary outcome was neurodevelopmental impairment (NDI) defined as cerebral palsy, cognitive delay, major or minor visual impairment, or hearing impairment or deafness at 36 months' corrected age. Results In this retrospective cohort study of 1,452 neonates, 1,000 were eligible for the study and 881 (88.1%) were available for follow-up. There was no significant difference in mortality between VR group, CS-L group, and CS-NL group. At 3 years, there was no significant difference between the three groups in terms of NDI. The odds of composite outcome of mortality or NDI for neonates born via CS-NL versus VR, and CS-L versus VR were 0.90 (95% confidence interval [CI]: 0.59 to 1.37) and 1.08 (95% CI: 0.72 to 1.61), respectively. Propensity score-based matched-pair analyses did not show a significant association between the composite outcome and CS with or without labour. Conclusions CS was not associated with increased survival or decreased risk of NDI in premature singleton neonates born at less than 29 weeks' gestation.
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Affiliation(s)
- Abhay Lodha
- Cumming School of Medicine, University of Calgary, Calgary, Alberta.,Alberta Health Services, Calgary, Alberta.,Department of Pediatrics, Foothills Medical Center, Calgary, Alberta.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta
| | - Krystyna Ediger
- Cumming School of Medicine, University of Calgary, Calgary, Alberta.,Alberta Health Services, Calgary, Alberta.,Department of Pediatrics, Foothills Medical Center, Calgary, Alberta
| | - Dianne Creighton
- Alberta Health Services, Calgary, Alberta.,Department of Pediatrics, Foothills Medical Center, Calgary, Alberta
| | | | - Arijit Lodha
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta
| | - Stephen Wood
- Cumming School of Medicine, University of Calgary, Calgary, Alberta.,Alberta Health Services, Calgary, Alberta.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta.,Department of Obstetrics & Gynaecology, Foothills Medical Center, Calgary, University of Calgary, Calgary, Alberta.,O' Brien Institute for Public Health, University of Calgary, Calgary, Alberta
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12
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Mekasha A, Tazu Z, Muhe L, Abayneh M, Gebreyesus G, Girma A, Berhane M, McClure EM, Goldenberg RL, Nigussie AK. Factors Associated with the Death of Preterm Babies Admitted to Neonatal Intensive Care Units in Ethiopia: A Prospective, Cross-sectional, and Observational Study. Glob Pediatr Health 2020; 7:2333794X20970005. [PMID: 33283024 PMCID: PMC7689001 DOI: 10.1177/2333794x20970005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/05/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022] Open
Abstract
Aim. To determine the risk factors for death among preterm
neonates. Methods and materials. The data set used was derived
from a prospective, multi-center, observational clinical study conducted in 5
tertiary hospitals in Ethiopia from July, 2016 to May, 2018. Subjects were
infants admitted into neonatal intensive care unit. Results.
Risk factors were determined using statistical model developed for this study.
The mean gestational age was 32.87 (SD ± 2.42) weeks with a range of 20 to
36 weeks. There were 2667 (70.69%) survivors and 1106 (29.31%) deaths. The
significant risk factors for preterm death were low gestational age, low birth
weight, being female, feeding problem, no antenatal care visits and vaginal
delivery among mothers with higher educational level.
Conclusions. The study identified several risk factors for
death among preterm neonates. Most of the risk factors are preventable. Thus, it
is important to address neonatal and maternal factors identified in this study
through appropriate ANC and optimum infant medical care and feeding practices to
decrease the high rate of preterm death.
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Affiliation(s)
- Amha Mekasha
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zelalem Tazu
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lulu Muhe
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mahlet Abayneh
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Goitom Gebreyesus
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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13
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Gaudineau A, Lorthe E, Quere M, Goffinet F, Langer B, Le Ray I, Subtil D. Planned delivery route and outcomes of cephalic singletons born spontaneously at 24-31 weeks' gestation: The EPIPAGE-2 cohort study. Acta Obstet Gynecol Scand 2020; 99:1682-1690. [PMID: 32557537 DOI: 10.1111/aogs.13939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/26/2020] [Accepted: 06/05/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The objective of this study was to investigate the association between planned mode of delivery and neonatal outcomes with spontaneous very preterm birth among singletons in cephalic presentation. MATERIAL AND METHODS Etude Epidémiologique sur les Petits Ages Gestationnels 2 is a French national, prospective, population-based cohort study of preterm infants. For this study, we included women with a singleton cephalic pregnancy and spontaneous preterm labor or preterm premature rupture of membranes at 24-31 weeks' gestation. The main exposure was the planned mode of delivery (ie planned vaginal delivery or planned cesarean delivery at the initiation of labor). The primary outcome was survival at discharge and secondary outcome survival at discharge without severe morbidity. Propensity scores were used to minimize indication bias in estimating the association. RESULTS The study population consisted of 1008 women: 206 (20.4%) had planned cesarean delivery and 802 (79.6%) planned vaginal delivery. In all, 723 (90.2%) finally had a vaginal delivery. Overall, 187 (92.0%) and 681 (87.0%) neonates in the planned cesarean delivery and planned vaginal delivery groups were discharged alive, and 156 (77.6%) and 590 (76.3%) were discharged alive without severe morbidity. After matching on propensity score, planned cesarean delivery was not associated with survival (adjusted odds ratio [aOR] 1.05, 95% confidence interval [CI] 0.48-2.28) or survival without severe morbidity (aOR 0.64, 95% CI 0.36-1.16). CONCLUSIONS Planned cesarean delivery for cephalic presentation at 24-31 weeks' gestation after preterm labor or preterm premature rupture of membranes does not improve neonatal outcomes.
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Affiliation(s)
- Adrien Gaudineau
- Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Department of Obstetrics and Gynecology, Center Hospitalier Princesse Grace, Monaco, Monaco
| | - Elsa Lorthe
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, University of Paris, Paris, France.,EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal
| | - Mathilde Quere
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, University of Paris, Paris, France
| | - François Goffinet
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, University of Paris, Paris, France.,AP-HP, Port-Royal Maternity, University Paris Descartes, Hôpitaux Universitaires Paris-Centre, Paris, France
| | - Bruno Langer
- Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Isabelle Le Ray
- Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Damien Subtil
- Pôle Femme Mère Nouveau-né, CHU Lille, Jeanne de Flandre Hospital, University of Lille, Lille, France
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14
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Jiang HL, Lu C, Wang XX, Wang X, Zhang WY. Cesarean section does not affect neonatal outcomes of pregnancies complicated with preterm premature rupture of membranes. Chin Med J (Engl) 2020; 133:25-32. [PMID: 31923101 PMCID: PMC7028204 DOI: 10.1097/cm9.0000000000000582] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Preterm premature rupture of membranes (PPROM) is associated with high neonatal morbidity and mortality. However, the influences of cesarean section (CS) on neonatal outcomes in preterm pregnancies complicated with PPROM are not well elucidated. The aim of this study was to investigate the influence of delivery modes on neonatal outcomes among pregnant women with PPROM. METHODS A retrospective cross-sectional study was conducted in 39 public hospitals in 14 cities in the mainland of China from January 1st, 2011 to December 31st, 2011. A total of 2756 singleton pregnancies complicated with PPROM were included. Adverse neonatal outcomes including early neonatal death, birth asphyxia, respiratory distress syndrome (RDS), pneumonia, infection, birth trauma, and 5-min/10-min Apgar scores were obtained from the hospital records. Binary variables and ordinal variables were respectively calculated by binary logistic regressions and ordinal regression. Numerical variables were compared by multiple linear regressions. RESULTS In total, 2756 newborns were involved in the analysis. Among them, 1166 newborns (42.31%) were delivered by CS and 1590 newborns belonged to vaginal delivery (VD) group. The CS proportion of PPROM obviously increased with the increase of gestational age (χ = 5.014, P = 0.025). Compared with CS group, VD was associated with a higher risk of total newborns mortality (odds ratio [OR], 2.38; 95% confidence interval [CI], 1.102-5.118; P = 0.027), and a lower level of pneumonia (OR, 0.32; 95% CI, 0.126-0.811; P = 0.016). However, after multivariable adjustment and stratification for gestational age, only pneumonia was significantly related with CS in 28 to 34 weeks group (OR, 0.34; 95% CI, 0.120-0.940; P = 0.038). There were no differences regarding to other adverse outcomes in the two groups, including neonatal mortality, birth asphyxia, Apgar scores, RDS, pneumonia, and sepsis. CONCLUSIONS The proportion of CS of pregnant women with PPROM was very high in China. The mode of delivery does not affect neonatal outcomes of pregnancies complicated with PPROM.
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Affiliation(s)
- Hai-Li Jiang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
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15
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Jarde A, Feng YY, Viaje KA, Shah PS, McDonald SD. Vaginal birth vs caesarean section for extremely preterm vertex infants: a systematic review and meta-analyses. Arch Gynecol Obstet 2019; 301:447-458. [DOI: 10.1007/s00404-019-05417-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/07/2019] [Indexed: 11/30/2022]
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16
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Mode of delivery and pregnancy outcomes in preterm birth: a secondary analysis of the WHO Global and Multi-country Surveys. Sci Rep 2019; 9:15556. [PMID: 31664121 PMCID: PMC6820722 DOI: 10.1038/s41598-019-52015-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/12/2019] [Indexed: 11/12/2022] Open
Abstract
Many studies have been conducted to examine whether Caesarean Section (CS) or vaginal birth (VB) was optimal for better maternal and neonatal outcomes in preterm births. However, findings remain unclear. Therefore, this secondary analysis of World Health Organization Global Survey (GS) and Multi-country Survey (MCS) databases was conducted to investigate outcomes of preterm birth by mode of delivery. Our sample were women with singleton neonates (15,471 of 237 facilities from 21 countries in GS; and 15,053 of 239 facilities from 21 countries in MCS) delivered between 22 and <37 weeks of gestation. We assessed association between mode of delivery and pregnancy outcomes in singleton preterm births by multilevel logistic regression adjusted for hierarchical data. The prevalences of women with preterm birth delivered by CS were 31.0% and 36.7% in GS and MCS, respectively. Compared with VB, CS was associated with significantly increased odds of maternal intensive care unit admission, maternal near miss, and neonatal intensive care unit admission but significantly decreased odds of fresh stillbirth, and perinatal death. However, since the information on justification for mode of delivery (MOD) were not available, our results of the potential benefits and harms of CS should be carefully considered when deciding MOD in preterm births.
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17
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Berger R, Abele H, Bahlmann F, Bedei I, Doubek K, Felderhoff-Müser U, Fluhr H, Garnier Y, Grylka-Baeschlin S, Helmer H, Herting E, Hoopmann M, Hösli I, Hoyme U, Jendreizeck A, Krentel H, Kuon R, Lütje W, Mader S, Maul H, Mendling W, Mitschdörfer B, Nicin T, Nothacker M, Olbertz D, Rath W, Roll C, Schlembach D, Schleußner E, Schütz F, Seifert-Klauss V, Steppat S, Surbek D. Prevention and Therapy of Preterm Birth. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/025, February 2019) - Part 2 with Recommendations on the Tertiary Prevention of Preterm Birth and the Management of Preterm Premature Rupture of Membranes. Geburtshilfe Frauenheilkd 2019; 79:813-833. [PMID: 31423017 DOI: 10.1055/a-0903-2735] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 01/25/2023] Open
Abstract
Aims This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recently published scientific literature, the experience of the members of the guideline commission and the views of self-help groups. Methods The members of the participating medical societies and organizations developed Recommendations and Statements based on the international literature. The Recommendations and Statements were adopted following a formal consensus process (structured consensus conference with neutral moderation, voting done in writing using the Delphi method to achieve consensus). Recommendations Part 2 of this short version of the guideline presents Statements and Recommendations on the tertiary prevention of preterm birth and the management of preterm premature rupture of membranes.
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Affiliation(s)
- Richard Berger
- Frauenklinik, Marienhaus Klinikum Neuwied, Neuwied, Germany
| | - Harald Abele
- Frauenklinik, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Franz Bahlmann
- Frauenklinik, Bürgerhospital Frankfurt, Frankfurt am Main, Germany
| | - Ivonne Bedei
- Frauenklinik, Klinikum Frankfurt Höchst, Frankfurt am Main, Germany
| | | | - Ursula Felderhoff-Müser
- Klinik für Kinderheilkunde I/Perinatalzentrum, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Herbert Fluhr
- Frauenklinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Yves Garnier
- Frauenklinik, Klinikum Osnabrück, Osnabrück, Germany
| | | | - Hanns Helmer
- Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien, Wien, Austria
| | - Egbert Herting
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Markus Hoopmann
- Frauenklinik, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Irene Hösli
- Frauenklinik, Universitätsspital Basel, Basel, Switzerland
| | - Udo Hoyme
- Frauenklinik, Ilm-Kreis-Kliniken, Arnstadt, Germany
| | | | - Harald Krentel
- Frauenklinik, Annahospital Herne, Elisabethgruppe Katholische Kliniken Rhein Ruhr, Herne, Germany
| | - Ruben Kuon
- Frauenklinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Wolf Lütje
- Frauenklinik, Evangelisches Amalie Sieveking-Krankenhaus Hamburg, Hamburg, Germany
| | - Silke Mader
- European Foundation for the Care of the Newborn Infants
| | - Holger Maul
- Frauenklinik, Asklepios Kliniken Hamburg, Hamburg, Germany
| | - Werner Mendling
- Deutsches Zentrum für Infektionen in Gynäkologie und Geburtshilfe an der Frauenklinik, Helios Universitätsklinikum Wuppertal, Wuppertal, Germany
| | | | | | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, Berlin, Germany
| | - Dirk Olbertz
- Abteilung Neonatologie und neonatologische Intensivmedizin, Klinikum Südstadt Rostock, Rostock, Germany
| | - Werner Rath
- Emeritus, Universitätsklinikum Aachen, Aachen, Germany
| | - Claudia Roll
- Vestische Kinder- und Jugendklinik Datteln, Universität Witten/Herdecke, Datteln, Germany
| | - Dietmar Schlembach
- Klinik für Geburtsmedizin, Klinikum Neukölln/Berlin Vivantes Netzwerk für Gesundheit, Berlin, Germany
| | | | - Florian Schütz
- Frauenklinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | | | - Daniel Surbek
- Universitäts-Frauenklinik, Inselspital, Universität Bern, Bern, Switzerland
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Fischer T, Mörtl M, Reif P, Kiss H, Lang U. Statement by the OEGGG with Review of the Literature on the Mode of Delivery of Premature Infants at the Limit of Viability. Geburtshilfe Frauenheilkd 2018; 78:1212-1216. [PMID: 30655647 PMCID: PMC6294639 DOI: 10.1055/a-0669-1480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 12/03/2022] Open
Abstract
In 2017, the Austrian Society for Paediatric and Adolescent Medicine (ÖGKJ) published a guideline on the primary care of premature infants at the limit of viability. In this guideline, it is recommended that a Caesarean section be preferred as mode of delivery with regard to an early preterm birth (22 + 0 – 24 + 6 weeks of pregnancy) due to an allegedly lower perinatal risk of cerebral haemorrhage. In contrast to this, the Austrian Society for Gynaecology and Obstetrics (OEGGG) considers there to be no clinical and scientific basis for this recommendation and the mode of delivery in the case of early preterm birth must be adapted to the individual maternal and foetal clinical situation. The international data available from the generally retrospective investigations show heterogeneous results regarding the mode of delivery. The prospective and randomised data in this regard are insufficient. A Cochrane analysis does not show any advantage in favour of a Caesarean delivery. The German-language guidelines (AWMF and Switzerland) make analogous recommendations for adapting the mode of delivery with regard to an early preterm birth individually to the respective clinical situation. In the case of an early preterm birth and a singleton in cephalic presentation, the OEGGG therefore recommends individual management of the delivery which takes the maternal and foetal clinical situation into account and also includes vaginal delivery as a mode of delivery in the clinical decision process.
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Affiliation(s)
- Thorsten Fischer
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Paracelsus Medizinischen Universität Salzburg, Salzburg, Austria
| | - Manfred Mörtl
- Frauenklinik des Klinikums Klagenfurt, Klagenfurt am Wörthersee, Austria
| | - Philipp Reif
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz, Graz, Austria
| | - Herbert Kiss
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde, Vienna, Austria
| | - Uwe Lang
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz, Graz, Austria
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19
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Beucher G, Charlier C, Cazanave C. [Diagnosis and management of intra-uterine infection: CNGOF Preterm Premature Rupture of Membranes Guidelines]. ACTA ACUST UNITED AC 2018; 46:1054-1067. [PMID: 30389543 DOI: 10.1016/j.gofs.2018.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine the diagnosis criteria and management of intra-uterine inflammation or infection (Triple I, III). METHODS PubMed and Cochrane Central databases search. RESULTS III is defined as an infection of the fetal membranes, and/or other components like the decidua, fetus, amniotic fluid or placenta. This word should be preferred to the word chorioamnionitis that is less precise (Professional consensus). III clinical signs exhibit poor limited sensibility and specificity (EL3). The diagnosis of III is retained in case of maternal fever (defined by a body temperature≥38°C) with no alternative cause identified and at least 2 signs among the following: fetal tachycardia>160 bpm for 10min or longer, uterine pain of labor, purulent fluid from the cervical canal (Professional consensus). Maternal hyperleukocytosis>20 giga/L in the absence of corticosteroids treatment or increased plasmatic C-reactive protein also argue for III, despite their limited sensibility and specificity (EL3). III requires prompt delivery (Grade A). III is not by itself an indication for cesarean delivery (Professional consensus). Antibiotic treatment should cover Streptococcus agalactiae and Escherichia coli. Antibiotics should be started immediately and maintained all over delivery, to reduce neonatal and maternal morbidity (Grade B). Treatment should rely on a combination of betalactamin and aminoglycoside (Grade B). After vaginal delivery, one single dose of antibiotic is required. Antibiotic duration should be longer in case of bacteremia. Longer duration could be considered in case of persistent fever or of cesarean delivery (Professional consensus).
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Affiliation(s)
- G Beucher
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France.
| | - C Charlier
- Service des maladies infectieuses et tropicales, centre d'infectiologie Necker-Pasteur Institut IMAGINE, université Paris Descartes, hôpital Necker-Enfants-malades, 149, rue de Sèvres, 75743 Paris cedex 15, France
| | - C Cazanave
- Service des maladies infectieuses et tropicales, groupe hospitalier Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France; Université Bordeaux, USC EA 3671, infections humaines à mycoplasmes et à chlamydiae, 33000 Bordeaux, France
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20
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Affiliation(s)
- Anna L David
- Institute for Women's Health; University College London; London WC1E 6HX UK
| | - Aung Soe
- Medway Maritime Hospital; Gillingham Kent ME7 5NY UK
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21
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Natarajan G, Shankaran S, Saha S, Laptook A, Das A, Higgins R, Stoll BJ, Bell EF, Carlo WA, D'Angio C, DeMauro SB, Sanchez P, Van Meurs K, Vohr B, Newman N, Hale E, Walsh M. Antecedents and Outcomes of Abnormal Cranial Imaging in Moderately Preterm Infants. J Pediatr 2018; 195:66-72.e3. [PMID: 29395186 PMCID: PMC5869095 DOI: 10.1016/j.jpeds.2017.11.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 10/09/2017] [Accepted: 11/16/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To describe the frequency and findings of cranial imaging in moderately preterm infants (born at 290/7-336/7 weeks of gestation) across centers, and to examine the association between abnormal imaging and clinical characteristics. STUDY DESIGN We used data from the Neonatal Research Network Moderately Preterm Registry, including the most severe early (≤28 days) and late (>28 days) cranial imaging. Stepwise logistic regression and CART analysis were performed after adjustment for gestational age, antenatal steroid use, and center. RESULTS Among 7021 infants, 4184 (60%) underwent cranial imaging. These infants had lower gestational ages and birth weights and higher rates of small for gestational age, outborn birth, cesarean delivery, neonatal resuscitation, and treatment with surfactant, compared with those without imaging (P < .0001). Imaging abnormalities noted in 15% of the infants included any intracranial hemorrhage (13.2%), grades 3-4 intracranial hemorrhage (1.7%), cystic periventricular leukomalacia (2.6%), and ventriculomegaly (6.6%). Histologic chorioamnionitis (OR, 1.47; 95% CI, 1.19-1.83), gestational age (0.95; 95% CI, 0.94-0.97), antenatal steroids (OR, 0.55; 95% CI, 0.41-0.74), and cesarean delivery (OR, 0.66; 95% CI, 0.53-0.81) were associated with abnormal imaging. The center with the highest rate of cranial imaging, compared with the lowest, had a higher risk of abnormal imaging (OR, 2.08; 95% CI, 1.10-3.92). On the classification and regression-tree model, cesarean delivery, center, antenatal steroids, and chorioamnionitis, in that order, predicted abnormal imaging. CONCLUSION Among the 60% of moderately preterm infants with cranial imaging, 15% had intracranial hemorrhage, cystic periventricular leukomalacia or late ventriculomegaly. Further correlation of imaging and long-term neurodevelopmental outcomes in moderately preterm infants is needed.
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Affiliation(s)
| | | | - Shampa Saha
- RTI International, Research Triangle Park, NC
| | - Abbot Laptook
- Women and Infants Hospital of Rhode Island, Providence, RI
| | - Abhik Das
- RTI International, Research Triangle Park, NC
| | - Rosemary Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Barbara J Stoll
- Department of Pediatrics, UT Health McGovern Medical School, Houston, TX
| | - Edward F Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Carl D'Angio
- University of Rochester Medical Center, Rochester, NY
| | - Sara B DeMauro
- Department of Pediatrics, University of Pennsylvania, PA
| | - Pablo Sanchez
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, OH
| | - Krisa Van Meurs
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA
| | - Betty Vohr
- Women and Infants Hospital of Rhode Island, Providence, RI
| | - Nancy Newman
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH
| | | | - Michele Walsh
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH
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22
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Šimják P, Smíšek J, Koucký M, Lamberská T, Plavka R, Hájek Z. Proactive approach at the limits of viability improves the short-term outcome of neonates born after 23 weeks' gestation. J Perinat Med 2018; 46:103-111. [PMID: 28343176 DOI: 10.1515/jpm-2016-0264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 02/22/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this single-center study was to identify factors that affect the short-term outcome of newborns delivered around the limits of viability. METHODS A group of 137 pregnant women who gave birth between 22+0/7 and 25+6/7 weeks of gestation was retrospectively studied. The center supports a proactive approach to infants around the limits of viability. Perinatal and neonatal characteristics were obtained and statistically evaluated. RESULTS A total of 166 live-born infants were enrolled during a 6-year period; 162 (97.6%) of them were admitted to the neonatal intensive care unit (ICU) and 119 (73.5%) survived until discharge. The decrease in neonatal mortality was associated with an advanced gestational age (P<0.001) and a completed course of corticosteroids (P=0.002). Neonatal morbidities were common among infants of all gestational ages. The incidence of severe intraventricular hemorrhage significantly depended on gestational age (P<0.001) and a completed course of corticosteroids (P=0.002). Survival without severe neonatal morbidities was 39.5% and occurred mostly after 24+0/7 weeks of gestation. CONCLUSION The short-term outcome of newborns delivered around the limits of viability is mostly affected by gestational age and antenatal corticosteroid treatment. A consistently proactive approach improves the survival of infants at the limits of viability. This is most pronounced in cases where the delivery is delayed beyond 24 completed gestational weeks.
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Affiliation(s)
- Patrik Šimják
- Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Apolinářská 18, 128-51, Prague 2, Czech Republic, Tel.: +420-224-967-012
| | - Jan Smíšek
- Division of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic.,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michal Koucký
- Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tereza Lamberská
- Division of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Richard Plavka
- Division of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Zdeněk Hájek
- Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
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23
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Gamaleldin I, Harding D, Siassakos D, Draycott T, Odd D. Significant intraventricular hemorrhage is more likely in very preterm infants born by vaginal delivery: a multi-centre retrospective cohort study. J Matern Fetal Neonatal Med 2017; 32:477-482. [DOI: 10.1080/14767058.2017.1383980] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - David Harding
- Women’s and Children’s Health, St. Michael’s Hospital, Bristol, UK
| | | | - Tim Draycott
- Women’s Health, Chilterns, Southmead Hospital, Bristol, UK
| | - David Odd
- Women’s and Children's Health, Southmead Hospital, Bristol, UK
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24
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Delivery room resuscitation and adverse outcomes among very low birth weight preterm infants. J Perinatol 2017; 37:1010-1016. [PMID: 28661514 DOI: 10.1038/jp.2017.99] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 05/17/2017] [Accepted: 05/22/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate risk factors and impact of delivery room cardiopulmonary resuscitation (DR-CPR) on very low birth weight (VLBW) preterm infants. STUDY DESIGN A national, population-based, observational study evaluating risk factors and short-term neonatal outcomes associated with DR-CPR among VLBW, extremely preterm infants (EPIs, 24 to 27 weeks' gestation) and very preterm infants (VPI, 28 to 31 weeks' gestation) born in 1995 to 2010. RESULTS Among 17 564 VLBW infants, 636 (3.6%) required DR-CPR. In the group of 6478 EPI, 412 (6.4%) received DR-CPR compared with 224 of 11 086 infants (2.0%) in the VPI group. EPI who underwent DR-CPR had higher odds ratios (ORs (95% confidence interval)) for mortality compared to EPI not requiring DR-CPR (OR 3.32 (2.58, 4.29)), grades 3 to 4 intraventricular hemorrhage (IVH) (OR 1.59 (1.20, 2.10)) and periventricular leukomalacia (OR 1.81 (1.17, 2.82)). DR-CPR among VPI was associated with higher ORs for mortality (OR 4.99 (3.59, 6.94)), early sepsis (OR 2.07 (1.05, 4.09)), grades 3 to 4 IVH (OR 3.74 (2.55, 5.50)) and grades 3 to 4 retinopathy of prematurity (ROP) (OR 2.53 (1.18, 5.41)) compared to VPI not requiring DR-CPR. Only 11% of infants in the EPI DR-CPR group had favorable outcomes compared with 44% in the VPI DR-CPR group. Significantly higher ORs for mortality, IVH and ROP were found in the VPI compared to the EPI group. CONCLUSION Preterm VLBW infants requiring DR-CPR were at increased risk of adverse outcomes compared to those not requiring CPR. This effect was more pronounced in the VPI group.
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25
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Humberg A, Härtel C, Paul P, Hanke K, Bossung V, Hartz A, Fasel L, Rausch TK, Rody A, Herting E, Göpel W. Delivery mode and intraventricular hemorrhage risk in very-low-birth-weight infants: Observational data of the German Neonatal Network. Eur J Obstet Gynecol Reprod Biol 2017; 212:144-149. [PMID: 28363188 DOI: 10.1016/j.ejogrb.2017.03.032] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/21/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Very-low-birth-weight infants (VLBWI) are frequently delivered by cesarean section (CS). However, it is unclear at what gestational age the benefits of spontaneous delivery outweigh the perinatal risks, i.e. intraventricular hemorrhage (IVH) or death. OBJECTIVES To assess the short-term outcome of VLBWI on IVH according to mode of delivery in a population-based cohort of the German Neonatal Network (GNN). STUDY DESIGN A total cohort of 2203 singleton VLBWI with a birth weight <1500g and gestational age between 22 0/7 and 36 6/7 weeks born and discharged between 1st of January 2009 and 31st of December 2015 was available for analysis. VLBWI were stratified into three categories according to mode of delivery: (1) planned cesarean section (n=1381), (2) vaginal delivery (n=632) and (3) emergency cesarean section (n=190). Outcome was assessed in univariate and logistic regression analyses. RESULTS Prevalence of IVH was significantly higher in the vaginal delivery (VD) (26.6%) and emergency CS group (31.1%) as compared to planned CS (17.2%), respectively. In a logistic regression analysis including known risk factors for IVH, vaginal delivery (OR 1.725 [1.325-2.202], p≤0.001) and emergency cesarean section (OR 1.916 [1.338-2.746], p≤0.001) were independently associated with IVH risk. In the subgroup of infants >30 weeks of gestation prevalence for IVH was not significantly different in VD and planned CS (5.3% vs. 4.4%). CONCLUSIONS Our observational data demonstrate that elective cesarean section is associated with a reduced risk of IVH in preterm infants <30 weeks gestational age when presenting with preterm labor.
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Affiliation(s)
- Alexander Humberg
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany.
| | - Christoph Härtel
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - Pia Paul
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - Kathrin Hanke
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - Verena Bossung
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - Annika Hartz
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - Laura Fasel
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - Tanja K Rausch
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany; Institute of Medical Biometry and Statistics, University of Luebeck, University Medical Center of Schleswig-Holstein, Campus Luebeck, Germany
| | - Achim Rody
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - Egbert Herting
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
| | - Wolfgang Göpel
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany
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26
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Gemmell L, Martin L, Murphy KE, Modi N, Håkansson S, Reichman B, Lui K, Kusuda S, Sjörs G, Mirea L, Darlow BA, Mori R, Lee SK, Shah PS, Shah PS. Hypertensive disorders of pregnancy and outcomes of preterm infants of 24 to 28 weeks' gestation. J Perinatol 2016; 36:1067-1072. [PMID: 27583388 DOI: 10.1038/jp.2016.133] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/28/2016] [Accepted: 07/15/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To examine the relationship between hypertensive disorders of pregnancy (HDPs) and mortality and major morbidities in preterm neonates born at 24 to 28 weeks of gestation. STUDY DESIGN Using an international cohort, we retrospectively studied 27 846 preterm neonates born at 240 to 286 weeks of gestation during 2007 to 2010 from 6 national neonatal databases. The incidence of HDP was compared across countries, and multivariable logistic regression analyses were conducted to examine the association of HDP and neonatal outcomes including mortality to discharge, bronchopulmonary dysplasia, severe brain injury, necrotizing enterocolitis and treated retinopathy of prematurity. RESULTS The incidence of HDP in the entire cohort was 13% (range 11 to 16% across countries). HDP was associated with reduced odds of mortality (adjusted odds ratio (aOR) 0.77; 95% confidence interval (CI) 0.67 to 0.88), severe brain injury (aOR 0.74; 95% CI 0.62 to 0.89) and treated retinopathy (aOR 0.82; 95% CI 0.70 to 0.96), but increased odds of bronchopulmonary dysplasia (aOR 1.16; 95% CI 1.05 to 1.27). CONCLUSIONS In comparison with neonates born to mothers without HDP, neonates of HDP mothers had lower odds of mortality, severe brain injury and treated retinopathy, but higher odds of bronchopulmonary dysplasia. The impact of maternal HDP on newborn outcomes was inconsistent across outcomes and among countries; therefore, further international collaboration to standardize terminology, case definition and data capture is warranted.
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Affiliation(s)
- L Gemmell
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - L Martin
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - K E Murphy
- Department of Obstetrics and Gynecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - N Modi
- UK Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - S Håkansson
- Swedish Neonatal Quality Register, Department of Pediatrics/Neonatal Services, Umeå University Hospital, Umeå, Sweden
| | - B Reichman
- Israel Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer, Israel
| | - K Lui
- Australian and New Zealand Neonatal Network, Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, University of New South Wales, Randwick, New South Wales, Australia
| | - S Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - G Sjörs
- Swedish Neonatal Quality Register, Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
| | - L Mirea
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - B A Darlow
- Australia and New Zealand Neonatal Network, Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - R Mori
- Neonatal Research Network Japan, Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - S K Lee
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - P S Shah
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
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27
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Mottet N, Riethmuller D. [Mode of delivery in spontaneous preterm birth]. ACTA ACUST UNITED AC 2016; 45:1434-1445. [PMID: 27776847 DOI: 10.1016/j.jgyn.2016.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the benefit/risk balance of way of birth according to fetal presentation, to assess monitoring during preterm labor, to discuss method of delivery and practice of delayed cord clamping in case of spontaneous preterm birth. METHODS Bibliographic research from the Pubmed database and recommendations issued by the main scientific societies, and assignment of a level of evidence and a recommendation grade. RESULTS In case of vertex presentation, no studies suggest that cesarean section improve neonatal outcome during spontaneous preterm birth (LE4). Nevertheless, cesarean is associated with higher maternal morbidity than vaginal delivery. Thus, routine cesarean is not recommended simply because of a spontaneous preterm labor (professional consensus). The available data do not allow specific recommendations about the choice of mode of delivery for preterm breech presentation in view of the low levels of proof (Professional consensus). Fetal rate monitoring is necessary during preterm labor (Professional consensus). Current data about second lines method for fetal surveillance (fetal scalp blood for pH or lactates) are insufficient to recommend their use before 34 WG (Professional consensus). Systematic assisted vaginal delivery is not recommended during preterm birth (Professional consensus). Use of vacuum is possible after 34 WG when cranial vertex ossification is considered satisfactory (Professional consensus). Systematic use of episiotomy in case of preterm birth is not recommended (Professional consensus). A delayed cord clamping is possible if the neonatal or maternal state so permits (Professional consensus). The available data are insufficient to recommend a systematic use of this procedure (LE3). CONCLUSION In case of preterm delivery, the available data do not allow specific recommendations about the choice of mode of delivery regardless of fetal presentation.
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Affiliation(s)
- N Mottet
- Pôle Mère-Femme, CRHU Jean-Minjoz, 3, boulevard Flemming, 25030 Besançon cedex, France; Université de Franche comté, 25000 Besançon, France.
| | - D Riethmuller
- Pôle Mère-Femme, CRHU Jean-Minjoz, 3, boulevard Flemming, 25030 Besançon cedex, France; Université de Franche comté, 25000 Besançon, France
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28
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Simões R, Cavalli RC, Bernardo WM, Salomão AJ, Baracat EC. Cesarean delivery and prematurity. Rev Assoc Med Bras (1992) 2016; 61:489-94. [PMID: 26841156 DOI: 10.1590/1806-9282.61.06.489] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ricardo Simões
- Federação Brasileira das Associações de Ginecologia e Obstetrícia, Brazil
| | | | | | - Antônio J Salomão
- Federação Brasileira das Associações de Ginecologia e Obstetrícia, Brazil
| | - Edmund C Baracat
- Federação Brasileira das Associações de Ginecologia e Obstetrícia, Brazil
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Abstract
OBJECTIVE Despite the current prevalence of preterm births, no clear guidelines exist on the optimal mode of delivery. Our objective was to investigate the effects of mode of delivery on neonatal outcomes among premature infants in a large cohort. STUDY DESIGN We applied a retrospective cohort study design to a database of 6,408 births. Neonates were stratified by birth weight and a composite score was calculated to assess neonatal outcomes. The results were then further stratified by fetal exposure to antenatal steroids, birth weight, and mode of delivery. RESULTS No improvement in neonatal outcome with cesarean delivery (CD) was noted when subjects were stratified by mode of delivery, both in the presence or absence of antenatal corticosteroid administration. In the 1,500 to 1,999 g subgroup, there appears to be an increased risk of respiratory distress syndromes in neonates born by CD. CONCLUSION In our all-comers cohort, replicative of everyday obstetric practice, CD did not improve neonatal outcomes in preterm infants.
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Affiliation(s)
- Diana A Racusin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Kathleen M Antony
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Jennifer Haase
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Melissa Bondy
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Kjersti M Aagaard
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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30
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Barzilay E, Gadot Y, Koren G. Safety of vaginal delivery in very low birthweight vertex singletons: a meta-analysis. J Matern Fetal Neonatal Med 2016; 29:3724-9. [PMID: 26769191 DOI: 10.3109/14767058.2016.1141889] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective of this study is to assess the safety of vaginal delivery in VLBW singletons in the vertex presentation. METHODS MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched for studies on mode of delivery and neonatal outcome in VLBW singletons in the vertex presentation. A total of 28 studies met our inclusion criteria. RESULTS Vaginal delivery was not associated with an increase in overall neonatal mortality compared with cesarean delivery (OR 0.87, 95% CI 0.72-1.04). Vaginal delivery was associated with a significant decrease in mortality for the 1250-1500 g birthweight category (OR 0.57, 95% CI 0.36-0.92), while an increase in mortality in the 500-750 g category was not significant (OR 1.5, 95% CI 0.86-2.61). Severe intraventricular hemorrhage (IVH) was not associated with mode of delivery (OR 1.05, 95% CI 0.85-1.29), but the only two high quality study that assessed IVH of all grades found an increase in risk for IVH in vaginal delivery (OR 1.33, 95% CI 1.16-1.51). CONCLUSIONS Vaginal delivery does not appear to increase the risk for neonatal mortality. However, current available data on neonatal morbidity are limited. More high-quality studies are needed to assess the association between mode of delivery and neonatal morbidity.
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Affiliation(s)
- Eran Barzilay
- a Department of Obstetrics and Gynecology , Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Yifat Gadot
- b Department of Obstetrics and Gynecology , Kaplan Medical Center , Rehovot , Israel , and
| | - Gideon Koren
- c Motherisk Program, Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children and University of Toronto , Toronto , ON , Canada
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31
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Turitz AL, Friedman AM, Gyamfi-Bannerman C. Trial of labor after cesarean versus repeat cesarean in women with small-for-gestational age neonates: a secondary analysis. J Matern Fetal Neonatal Med 2015; 29:3051-5. [DOI: 10.3109/14767058.2015.1114084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Amy L. Turitz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Alexander M. Friedman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Cynthia Gyamfi-Bannerman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
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Perinatal factors associated with active intensive treatment at the border of viability: a population-based study. J Perinatol 2015; 35:705-11. [PMID: 25973945 DOI: 10.1038/jp.2015.48] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 02/16/2015] [Accepted: 03/31/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this national population-based study was to identify perinatal and neonatal factors associated with active intensive treatment (AIT) of infants born at the periviable period of 22 to 24 weeks of gestation. STUDY DESIGN Data from the Israel national very low-birth weight infant database on 2207 infants born alive in 1995 to 2010 at gestational age (GA) 22 to 24 weeks were evaluated. AIT was defined as endotracheal intubation in the delivery room or mechanical ventilation in the neonatal intensive care unit. Multivariable logistic regression analyses were used to identify the independent effect of demographic and perinatal factors on AIT for each gestational week. RESULT Of the 2207 infants born at 22 to 24 weeks GA, 1643 (74.4%) received AIT and 564 (25.6%) received comfort care. AIT increased from 25.5% at 22 weeks to 62.7 and 93.5% at 23 and 24 weeks GA, respectively, reflecting a 4.66 (95% confidence interval (CI) 3.32 to 6.54)- and 29.8 (95% CI 19.9 to 44.6)-fold odds for AIT at 23 and 24 weeks GA, respectively, compared with 22-week GA infants. Perinatal treatments associated with AIT included maternal tocolytic therapy (odds ratio (OR) 1.51, 95% CI 1.04 to 2.20), prenatal steroid therapy, both partial (OR 3.30, 95% CI 2.14 to 5.10) and complete (OR 3.17, 95% CI 1.91 to 5.26) and cesarean delivery (OR 2.68, 95% CI 1.88 to 3.83). Each unit increase in birth weight z-score was associated with an OR of 1.58 (95% CI 1.30 to 1.92) for AIT. At 22 weeks GA, maternal tocolytic treatment was associated with higher odds of AIT. In the 23 and 24-week GA infants, maternal infertility treatment, antenatal steroids, cesarean delivery and higher-birth weight z-scores were significantly associated with AIT. Among 23-week GA infants, AIT decreased significantly in the period 2006 to 2010 compared with 1995 to 2000 (OR 0.51, 95% CI 0.34 to 0.77). CONCLUSION An active approach in obstetric management of pregnancies appears to impact the neonatologists' decision to undertake AIT treatment in infants born at the border of viability. The higher odds for AIT associated with obstetric interventions might contribute to the reported beneficial effect of antenatal steroids and cesarean delivery on the survival of infants born at the border of viability.
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Abstract
Management and decision whether to begin intensive care for very preterm infants below 26 WG and at borderline viability remains controversial, and survival rates for these children vary greatly and justify discussion with regards to literature data and according to the experience of others countries. If active management is more difficult with very preterm infants 24-25 WG, mortality is increased comparing with newborns of more than 26 WG. This is partly explained by limitations of active neonatal intensive care. Nevertheless, neurocomportemental and cognitive results are not so unfavorable. This justifies a human, medical, and ethical multidiciplinary discussion including the parents' wishes for an active resuscitation or a palliative management. Using the only criteria of gestational age is not a reliable tool to predict survival and neurodevelopmental outcome of preterm infants. It is very important to identify other prenatal factors such prenatal corticosteroid administration, gender, fetal estimated weight, amniotic fluid and absent/reverse end diastolic flow umbilical doppler. Implication and listening the parents' preferences are essential after individual information, objective and a honest counseling including mortality, morbidity and risks of neurocomportmental impairments. Birth and counseling should be done in reference maternofetal center with obstetricians and neonatalogist specialized in this topic. A real difficulty is to consider the route of delivery and the possibility that caesarean section could improve survival rates. Induction of labour is very often a high risk of failure and route of delivery remains controversial and this is a real question in order to improve survival rates. Literature is poor and conflicting without randomized trials. Caesarean section presents maternal risks such as pathologic placentation, haemorrhage delivery and increasing risks for the subsequent gestation. So, if it is not a good idea to recommend a systematic caesarean delivery, it is not ethical to refuse this route of delivery only because of the gestational age even in extremely premature birth.
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Affiliation(s)
- N Winer
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex, France.
| | - C Flamant
- Service de réanimation et médecine néonatale, hôpital Mère-Enfant, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex, France
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Cetinkaya SE, Okulu E, Soylemez F, Akin İM, Sahin S, Akyel T, Alan S, Atasay B, Arsan S, Koc A. Perinatal risk factors and mode of delivery associated with mortality in very low birth weight infants. J Matern Fetal Neonatal Med 2014; 28:1318-1323. [PMID: 25208229 DOI: 10.3109/14767058.2014.953476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate the association of perinatal risk factors including delivery mode with mortality in very low birthweight (VLBW) in a tertiary hospital setting. METHODS Medical records of 241 live-born VLBW infants (≤1500 g) were retrospectively reviewed. Details of maternal, obstetrical, perinatal risk factors and their associations with infant mortality were evaluated. RESULTS The overall infant mortality rate was 23.2%. Mortality was significantly higher for infants born at ≤27 gestational weeks and with a birthweight of ≤750 g (p = 0.000 and p = 0.000, respectively), showing a steep decrease thereafter. On ROC analysis, a cut off of 26.5 weeks was determined for mortality with a sensitivity of 57.1% and a specificity of 90.3% (area under the curve = 0.792, 95% CI: 0.719-0.866). On multivariate regression analysis, gestational week at birth, birthweight, antenatal steroid treatment and pathologic Doppler ultrasound findings were found as independent risk factors for mortality. CONCLUSIONS Gestational week at birth, birthweight and antenatal steroid treatment remain the most important perinatal risk factors for infant mortality in VLBW infants. Mode of delivery does not seem to be associated with mortality when adjusted for other perinatal risk factors.
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Affiliation(s)
| | - Emel Okulu
- b Division of Neonatology, Department of Pediatrics , and
| | - Feride Soylemez
- c Division of Perinatology, Department of Obstetrics and Gynecology , Ankara University School of Medicine , Ankara , Turkey
| | | | - Seda Sahin
- a Department of Obstetrics and Gynecology
| | | | - Serdar Alan
- b Division of Neonatology, Department of Pediatrics , and
| | - Begum Atasay
- b Division of Neonatology, Department of Pediatrics , and
| | - Saadet Arsan
- b Division of Neonatology, Department of Pediatrics , and
| | - Acar Koc
- c Division of Perinatology, Department of Obstetrics and Gynecology , Ankara University School of Medicine , Ankara , Turkey
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Zhu JJ, Bao YY, Zhang GL, Ma LX, Wu MY. No relationship between mode of delivery and neonatal mortality and neurodevelopment in very low birth weight infants aged two years. World J Pediatr 2014; 10:227-31. [PMID: 25124973 DOI: 10.1007/s12519-014-0497-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 03/14/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND To compare neonatal mortality and neurodevelopmental outcomes at two years of age in very low birth weight infants (≤1500 g) born by cesarean with those by vaginal delivery. METHODS In this retrospective, case-control study, we evaluated neonatal mortality, medical conditions and neurodevelopmental outcomes at two years of corrected age in 710 very low birth weight (VLBW) infants born between January 2005 and December 2010. Of the 710 infants, 351 were born by the cesarean and 359/710 by vaginal route. RESULTS There were no significant differences in neonatal mortality between the cesarean delivery group and vaginal delivery group [56/351 (15.9%) vs. 71/359 (19.8%), P=0.20]. VLBW infants delivered by the cesarean procedure had a higher incidence of respiratory distress syndrome than those born by the vaginal route [221/351 (63.0%) vs. 178/359 (49.6%), P<0.001]. There were no differences in other neonatal morbidities, including intraventricular hemorrhage [126/351 (35.9%) vs. 134/359 (37.3%), P=0.69], bronchopulmonary dysplasia [39/351 (11%) vs. 31/359 (8.6%), P=0.38] and necrotising enterocolitis [40/351 (11.4%) vs. 32/359 (8.9%), P=0.32] between the two groups. The incidence of poor neurodevelopment after cesarean delivery was similar to that after vaginal delivery [105/351 (29.9) vs. 104/359 (29.0%), P=0.78]. CONCLUSIONS In neither neurodevelopment nor neonatal mortality did cesarean birth offered significant advantages to VLBW infants. Moreover, the operation might be associated with an increased risk of respiratory distress syndrome for VLBW infants. The mode of delivery of VLBW infants should be largely based on obstetric indications and maternal considerations rather than perceived better outcomes for the neonate.
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Affiliation(s)
- Jia-Jun Zhu
- Department of Neonatology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
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Regev RH, Arnon S, Litmanovitz I, Bauer-Rusek S, Boyko V, Lerner-Geva L, Reichman B. Outcome of singleton preterm small for gestational age infants born to mothers with pregnancy-induced hypertension. A population-based study. J Matern Fetal Neonatal Med 2014; 28:666-73. [DOI: 10.3109/14767058.2014.928851] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Survival rate of extremely low birth weight infants and its risk factors: case-control study in Japan. ISRN OBSTETRICS AND GYNECOLOGY 2013; 2013:873563. [PMID: 24371528 PMCID: PMC3858981 DOI: 10.1155/2013/873563] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 10/09/2013] [Indexed: 11/18/2022]
Abstract
Aim. To clarify the effect of perinatal events on the survival of ELBW infants in Japan. Methods. 1,713 ELBW infants, from 92,630 live births in 2001 and 2002, born at 22–36 weeks of gestation were registered. Case was defined as death at discharge. The relevant variables were compared between the cases (n = 366) and the controls (n = 1,347). Results. The total survival rate was 78.6%. There was a significant difference between the survival rate in cesarean and vaginal delivery at 24–31 weeks of gestation. Cesarean delivery in infants with a birth weight >400 g was significantly advantageous to the survival rate of ELBW infants than vaginal delivery. The significant contributing factors were gestational age at delivery (OR: 0.97), Apgar score at 5 min (0.56), antenatal steroid (0.41), and birth weight (0.996). Nonvertex presentation (1.81), vaginal delivery (1.56), and placental abruption (2.50) were found to be significantly associated with neonatal death. Conclusions. Cesarean section might be advantageous for survival in ELBW infants over 24 gestational weeks or 400 grams of birth weight. Nonvertex presentation, vaginal delivery, and placental abruption could be significant risk factors for survival of ELBW infants.
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Health outcomes for vaginal compared with cesarean delivery of appropriately grown preterm neonates. Obstet Gynecol 2013; 121:1195-1200. [PMID: 23812452 DOI: 10.1097/aog.0b013e3182918a7e] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the association between route of delivery and neonatal outcomes in a large, diverse cohort of preterm, appropriate-for-gestational-age neonates. METHODS This is a retrospective cohort study examining New York City birth data for 1995-2003 linked to hospital discharge data. Data were limited to singleton, live-born, cephalic neonates delivered between 24 and 34 weeks of gestation. Exclusion criteria included congenital anomalies, forceps or vacuum assistance, birth weight missing, less than 500 g, or not appropriate for gestational age. Any neonatal diagnosis of intraventricular hemorrhage, seizure, sepsis, subdural hemorrhage, respiratory distress, 5-minute Apgar score less than 7, or neonatal death was considered significant. Associations between method of delivery and neonatal morbidities were estimated using logistic regression. RESULTS Of 20,231 neonates meeting study criteria, 69.3% were delivered vaginally and 30.7% were delivered by cesarean. After controlling for maternal age, ethnicity, education, primary payer, prepregnancy weight, gestational age, diabetes, and hypertension, cesarean delivery compared with vaginal delivery was associated with increased odds of respiratory distress (39.2% compared with 25.6%, adjusted odds ratio [OR] 1.74, 95% confidence interval [CI] 1.61-1.89) and 5-minute Apgar score less than 7 (10.7% compared with 5.8%, adjusted OR 2.04, 95% CI 1.77-2.35). CONCLUSION In this preterm cohort, cesarean delivery was not protective against poor outcomes and in fact was associated with increased risk of respiratory distress and low Apgar score compared with vaginal delivery.
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Bilder DA, Pinborough-Zimmerman J, Bakian AV, Miller JS, Dorius JT, Nangle B, McMahon WM. Prenatal and perinatal factors associated with intellectual disability. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2013; 118:156-176. [PMID: 23464612 DOI: 10.1352/1944-7558-118.2.156] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Prenatal and perinatal risk factors associated with intellectual disability (ID) were studied in 8-year-old Utah children from a 1994 birth cohort (N = 26,108) using broad ascertainment methods and birth records following the most current recording guidelines. Risk factor analyses were performed inclusive and exclusive of children with a known or suspected underlying genetic disorder. Risk factors identified were poly/oligohydramnios, advanced paternal/maternal age, prematurity, fetal distress, premature rupture of membranes, primary/repeat cesarean sections, low birth weight, assisted ventilation greater than 30 min, small-for-gestational age, low Apgar scores, and congenital infection. Although several risk factors lost significance once children with underlying genetic disorders were excluded, socioeconomic variables were among those that maintained a prominent association with increased ID risk.
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Affiliation(s)
- Deborah A Bilder
- University of Utah School of Medicine, Psychiatry, Salt Lake City, UT, USA
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Perinatal risk factors for bronchopulmonary dysplasia in a national cohort of very-low-birthweight infants. Am J Obstet Gynecol 2013. [PMID: 23178245 DOI: 10.1016/j.ajog.2012.11.026] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We sought to assess the independent effect of perinatal factors on the risk for bronchopulmonary dysplasia (BPD) in very-low-birthweight infants. STUDY DESIGN This was a population-based observational study. Data were prospectively collected by the Israel Neonatal Network. Multivariable analyses identified independent risk factors for BPD. RESULTS Of 12,139 infants surviving to a postmenstrual age of 36 weeks, 1663 (13.7%) developed BPD. BPD was independently associated with young maternal age (odds ratio [OR], 1.53), maternal hypertensive disorders (OR, 1.28), antepartum hemorrhage (OR, 1.26), male gender (OR, 1.41), non-Jewish ethnicity (OR, 1.23), birth defects (OR, 1.94), small for gestational age (GA) (OR, 2.65), and delivery room resuscitation (OR, 1.86). Stratified analysis by GA groups showed that postdelivery resuscitation had a more pronounced effect with increasing maturity. CONCLUSION Perinatal factors and pregnancy complications were independently associated with development of BPD in very-low-birthweight infants. Most risk factors identified were consistent within GA groups.
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Assisting instrumental delivery for breech babies at the limits of viability. Arch Gynecol Obstet 2013; 288:449-51. [DOI: 10.1007/s00404-013-2716-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 01/10/2013] [Indexed: 10/27/2022]
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Abstract
OBJECTIVE To compare neonatal outcomes by method of delivery in preterm (34 weeks of gestation or prior), small-for-gestational-age (SGA) newborns in a large diverse cohort. METHODS Birth data for 1995-2003 from New York City were linked to hospital discharge data. Data were limited to singleton, liveborn, vertex neonates delivered between 25 and 34 weeks of gestation. Births complicated by known congenital anomalies and birth weight less than 500 g were excluded. Small for gestational age was used as a surrogate for intrauterine growth restriction. Associations between method of delivery and neonatal morbidities were estimated using logistic regression. RESULTS Two thousand eight hundred eighty-five SGA neonates meeting study criteria were identified; 42.1% were delivered vaginally, and 57.9% were delivered by cesarean. There was no significant difference in intraventricular hemorrhage, subdural hemorrhage, seizure, or sepsis between the cesarean delivery and vaginal delivery groups. Cesarean delivery compared with vaginal delivery was associated with increased odds of respiratory distress syndrome. The increased odds persisted after controlling for maternal age, parity, ethnicity, education, primary payer, prepregnancy weight, gestational age at delivery, diabetes, and hypertension. CONCLUSION Cesarean delivery was not associated with improved neonatal outcomes in preterm SGA newborns and was associated with an increased risk of respiratory distress syndrome.
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Biswas A, Su LL, Mattar C. Caesarean section for preterm birth and, breech presentation and twin pregnancies. Best Pract Res Clin Obstet Gynaecol 2012; 27:209-19. [PMID: 23062593 DOI: 10.1016/j.bpobgyn.2012.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 09/11/2012] [Indexed: 11/25/2022]
Abstract
Caesarean section incidence is steadily rising worldwide; the major contributor to this rise is pregnancies with previous caesarean section. Hence, it is important to scrutinise carefully the indication of primary caesarean sections. Preterm births, breech presentation and twin pregnancies together complicate 12-18% of all births. The role of caesarean section in these pregnancies is controversial and lacks good evidence-based guidelines. Policy on mode of delivery in these three important obstetric groups is bound to influence overall primary caesarean section rates. In this chapter, we review the evidence on the place of caesarean delivery in these three important groups.
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Affiliation(s)
- Arijit Biswas
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, National University Health Systems and National University of Singapore, Level 12, NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228, Singapore.
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Reddy UM, Zhang J, Sun L, Chen Z, Raju TNK, Laughon SK. Neonatal mortality by attempted route of delivery in early preterm birth. Am J Obstet Gynecol 2012; 207:117.e1-8. [PMID: 22840720 PMCID: PMC3408612 DOI: 10.1016/j.ajog.2012.06.023] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 05/13/2012] [Accepted: 06/13/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We sought to study neonatal outcomes in early preterm births by delivery route. STUDY DESIGN Delivery precursors were analyzed in 4352 singleton deliveries, 24 0/7 to 31 6/7 weeks' gestation. In a subset (n = 2906) eligible for a trial of labor, neonatal mortality in attempted vaginal delivery (VD) was compared to planned cesarean delivery stratified by presentation. RESULTS Delivery precursors were classified as maternal or fetal conditions (45.7%), preterm premature rupture of membranes (37.7%), and preterm labor (16.6%). For vertex presentation, 79% attempted VD and 84% were successful. There was no difference in neonatal mortality. For breech presentation, at 24 0/7 to 27 6/7 weeks' gestation, 31.7% attempted VD and 27.6% were successful; neonatal mortality was increased (25.2% vs 13.2%, P = .003). At 28 0/7 to 31 6/7 weeks' gestation, 30.5% attempted VD and 17.2% were successful; neonatal mortality was increased (6.0% vs 1.5%, P = .016). CONCLUSION Attempted VD for vertex presentation has a high success rate with no difference in neonatal mortality unlike breech presentation.
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Affiliation(s)
- Uma M Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Review of the recent literature on the mode of delivery for singleton vertex preterm babies. J Pregnancy 2011; 2011:186560. [PMID: 21811682 PMCID: PMC3147000 DOI: 10.1155/2011/186560] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Accepted: 05/26/2011] [Indexed: 11/17/2022] Open
Abstract
Choosing the safest method of delivery and preventing preterm labour are obstetric challenges in reducing the number of preterm births and improving outcomes for mother and baby. Optimal route of delivery for preterm vertex neonates has been a controversial topic in the obstetric and neonatal community for decades and continues to be debated. We reviewed 22 studies, most of which have been published over the last five years with an aim to find answers to the clinical questions relevant to deciding the mode of delivery. Findings suggested that the neonatal outcome does not depend on the mode of delivery. Though Caesarean section rates are increasing for preterm births, it does not prevent neurodisability and cannot be recommended unless there are other obstetric indications to justify it. Therefore, clinical judgement of the obstetrician depending on the individual case still remains important in deciding the mode of delivery.
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Klinger G, Levy I, Sirota L, Boyko V, Lerner-Geva L, Reichman B. Outcome of early-onset sepsis in a national cohort of very low birth weight infants. Pediatrics 2010; 125:e736-40. [PMID: 20231184 DOI: 10.1542/peds.2009-2017] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Early-onset sepsis (EOS) is associated with significant morbidity and mortality among infants with a very low birth weight (VLBW); however, there is a sparse amount of complete data on large cohorts. OBJECTIVE To evaluate the mortality and major morbidities among VLBW infants with EOS. METHODS This was a population-based observational study. Data were prospectively collected by the Israel Neonatal Network on all VLBW infants born in Israel from 1995 through 2005. Univariate and multivariable analyses were performed to assess the independent association of EOS on morbidity and mortality of VLBW infants. RESULTS The study cohort included 15 839 infants, of whom 383 (2.4%) developed EOS. EOS was associated with significantly increased odds for mortality (odds ratio [OR]: 2.57 [95% confidence interval (CI): 1.97-3.35]), severe intraventricular hemorrhage (OR: 2.24 [95% CI: 1.67-3.00]), severe retinopathy of prematurity (OR: 2.04 [95% CI: 1.32-3.16]), and bronchopulmonary dysplasia (OR: 1.74 [95% CI: 1.24-2.43]). EOS was associated with an increased risk of death and/or severe neurologic morbidity (OR: 2.92 [95% CI: 2.27-3.80]). CONCLUSIONS Although only 2.4% of VLBW infants had an episode of EOS, these infants were at an approximately threefold excess risk of death or major neurologic morbidities.
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Affiliation(s)
- Gil Klinger
- Department of Neonatology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petah Tiqva 49202, Israel.
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Ghi T, Maroni E, Arcangeli T, Alessandroni R, Stella M, Youssef A, Pilu G, Faldella G, Pelusi G. Mode of delivery in the preterm gestation and maternal and neonatal outcome. J Matern Fetal Neonatal Med 2010; 23:1424-8. [DOI: 10.3109/14767051003678259] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Skupski DW, Greenough A, Donn SM, Arabin B, Bancalari E, Vladareanu R. Delivery mode for the extremely premature fetus: a statement of the prematurity working group of the World Association of Perinatal Medicine. J Perinat Med 2010; 37:583-6. [PMID: 19681735 DOI: 10.1515/jpm.2009.126] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent retrospective publications have suggested that cesarean delivery may be beneficial for the extremely premature fetus. This article displays the available evidence and discusses this issue, including many aspects such as the difficulty in deciding when delivery is imminent, the negative impact on maternal morbidity and mortality and the cost to society of such a policy. The available scientific evidence does not support a recommendation for cesarean delivery for improving survival or decreasing morbidity for the extremely premature fetus.
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Affiliation(s)
- Daniel W Skupski
- Division of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
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Variability in caesarean section rates for very preterm births at 28-31 weeks of gestation in 10 European regions: results of the MOSAIC project. Eur J Obstet Gynecol Reprod Biol 2010; 149:147-52. [PMID: 20083337 DOI: 10.1016/j.ejogrb.2009.12.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 11/06/2009] [Accepted: 12/21/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Given the continuing debate about the benefits of caesarean section for very preterm infants, we sought to describe caesarean section rates for infants between 28 and 31 weeks of gestation in European regions and their association with regional mortality and short-term morbidity. STUDY DESIGN Singletons and twins without lethal congenital anomalies alive at onset of labour from 28 to 31 weeks of gestation from the 2003 MOSAIC cohort of very preterm births in 10 European regions were analysed (N=3,310). Determinants included maternal and fetal characteristics as well as regional caesarean section rates for all births. We explored correlations between caesarean section rates and mortality and morbidity on the regional level. RESULTS 95% of infants from pregnancies complicated by hypertension or severe growth restriction detected antenatally were delivered by caesarean section (regional range: 90-100%) versus 55.4% (range: 29-84%) for other pregnancies. Regional caesarean section rates for births at all gestations ranged from 14% to 38% and were correlated with very preterm caesarean rates (p=0.011). Determinants of caesarean section differed between regions with high versus low rates: multiples were more likely to be born by caesarean section in regions with high rates. There were no regional level correlations between caesarean section rates and mortality and morbidity. CONCLUSIONS With the exception of pregnancies with hypertension and growth restriction, there was broad variation in very preterm caesarean section rates between regions after adjustment for clinical factors. Given maternal risks associated with caesarean section, more research on its optimal use for very preterm deliveries is necessary.
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Kollée LAA, Cuttini M, Delmas D, Papiernik E, den Ouden AL, Agostino R, Boerch K, Bréart G, Chabernaud JL, Draper ES, Gortner L, Künzel W, Maier RF, Mazela J, Milligan D, Van Reempts P, Weber T, Zeitlin J. Obstetric interventions for babies born before 28 weeks of gestation in Europe: results of the MOSAIC study. BJOG 2009; 116:1481-91. [DOI: 10.1111/j.1471-0528.2009.02235.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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