Short-term outcome after active perinatal management at 23-25 weeks of gestation. A study from two Swedish tertiary care centres. Part 1: maternal and obstetric factors (original) (raw)
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Acta obstetricia et gynecologica Scandinavica, 2015
A population-based observational study investigated the contribution of obstetric factors to the survival and postnatal development of extremely preterm infants. Mortality up to one year and neurodevelopment at 2.5 years (Bayley-III test, cerebral palsy, vision, hearing) were evaluated in infants born <27 gestational weeks in Sweden 2004-2007 (n=1,011), using logistic regression analyses of risk factors. Of 844 fetuses alive at admission, 8.4% died in utero before labour, 7.8% died intra partum. Of 707 live-born infants, 15% died within 24 h, 70% survived ≥365 days, 64% were assessed at 2.5 years. The risk of death within 24h after birth decreased with gestational age (OR 0.3; 95%CI: 0.2-0.4), antenatal corticosteroids (OR 0.3; 95%CI: 0.1-0.6), and cesarean section (OR 0.4; 95%CI: 0.2-0.9); it increased with multiple birth (OR 3.0; 95%CI: 1.5-6.0), vaginal breech delivery (OR 2.3; 95%CI: 1.0-5.1), 5-minute Apgar score <4 (OR 50.4; 95%CI: 28.2-90.2), and birth at level II hospi...
Late preterm births: a retrospective analysis of the morbidity risk stratified for gestational age
SpringerPlus, 2014
Purpose: Late-preterm births are considered functionally mature but, several line of evidences suggest that, compared with term neonates, they have a higher risk of complications. The aim of this study was to compare the incidence of maior clinical complications of late preterm infants born in our division, compared to those born at term. Methods: We retrospectively analysed late preterm deliveries occurred in a twenty-months period. Late preterms were divided in 3 sub-groups according to gestational age at delivery: 34 0/6 , 35 0/6 , 36 0/6 weeks of gestation. The incidence of maior clinical complications was evaluated. Statistical analysis was performed by using the Z-test.
A prospective study of maternal factors and perinatal outcome of preterm birth
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2019
Background: Preterm birth (PTB) is a leading cause of perinatal morbidity and mortality, henceforth being a major concern for the obstetricians and paediatricians as well being a major health care issue. Preventing and treating the associated risk factors could play a major role in curbing the perinatal morbidity and mortality.Methods: A total 100 women with preterm labour or an indicated preterm termination of pregnancy were enrolled in the study. They were evaluated by history taking, clinical examination, and ultrasonography. Corticosteroids were given to all the patients. Maternal risk factors, obstetric outcome and perinatal outcome till discharge were studied.Results: Of the 100 women studied, mean age of the cases was 27 years, 60% of the cases belonged to lower socio-economic class, 74% of the cases were under 55 kgs weight group and 77% of cases were anaemic. 34% cases were below 34 weeks of gestation, 58% were multigravida, and 2% grand multipara with 35% labour being indu...
American Journal of Obstetrics and Gynecology, 2003
OBJECTIVE: This study was undertaken to estimate the risk of fetal and maternal complications associated with postterm delivery in Denmark. STUDY DESIGN: A cross-sectional study that used records from the Danish Medical Birth Registry from 1978 to 1993 was performed. All women with registered prolonged pregnancy (n = 78,022) and a 5% random sample of all women who gave birth (n = 47,021) were linked to the Danish National Discharge Register. We established a postterm group of 77,956 singleton deliveries and a term group of 34,140 singleton spontaneous deliveries. Logistic regression models were used to analyze data. RESULTS: The risk of perinatal and obstetric complications was high in postterm delivery compared with term delivery (adjusted odds ratios between 1.2 and 3.1). The risk of perinatal death was 1.33 (1.05-1.68). CONCLUSION: Postterm delivery was associated with significantly increased risks of perinatal and maternal complications in Denmark in the period from 1978 to 1993. (Am J Obstet Gynecol 2003;189:222-7.)
PUBLIC HEALTH AND MANAGEMENT EPIDEMIOLOGICAL ASPECTS OF THE LATE PRETERM VERSUS TERM BIRTH
The rate of late premature births is increasing worldwide and in Romania. Purpose: To identify the particular epidemiological aspects associated with preterm compared to term birth. Materials and methods: The retrospective, case-control study included late preterm infants and term infants matched for birth weight (± 100 g). Results: The study group included 345 late preterm and 345 term neonates. Comparative analysis of the data of the two groups revealed: mothers of late preterm infants had a significantly higher mean age, higher number of previous pregnancies, originated more frequently from urban areas and had higher education background. Significant differences were also found as regards multiple pregnancies, pregnancies obtained by assisted reproductive techniques, and delivery circumstances. Conclusion: Late preterm birth is associated, in our study, with advanced maternal age, multiple pregnancy, use of assisted reproductive techniques, premature rupture of the amniotic membranes, and birth by caesarean section, consistent with data from the literature.
Acta Paediatrica, 2007
Aim: To determine major neonatal morbidity in surviving infants born at 23–25 weeks, and to identify maternal and infant factors associated with major morbidity. Methods: The medical records of 224 infants who were delivered at two tertiary care centres in 1992–1998 were reviewed retrospectively. At these centres, policies of active perinatal and neonatal management were universally applied. Of the 213 liveborn infants, 140 (66%) survived to discharge. Data were analysed by gestational age and considered in three time periods. Logistic regression models were used to identify factors associated with morbidity. Results: Of the survivors, 6% had intraventricular haemorrhage grade ± 3 (severe IVH) or periventricular leukomalacia (PVL), 15% retinopathy of prematurity ± stage 3 (severe ROP) and 36% bronchopulmonary dysplasia (BPD). On logistic regression analysis, severe IVH or PVL was associated with duration of mechanical ventilation (odds ratio, OR: 1.53 per 1-wk increment in duration; 95% confidence interval, CI: 1.01–2.33). Severe ROP was associated with the presence of a patent ductus arteriosus (PDA) (OR: 3.31; 95% CI: 1.11–9.90) and birth in time period 3 versus time periods 1 and 2 combined (OR: 6.28; 95% CI: 2.10–18.74). BPD was associated with duration of mechanical ventilation (OR: 2.71 per 1-wk increment in duration; 95% CI: 1.76–4.18) and with the presence of any obstetric complication (OR: 2.67; 95% CI: 1.07–6.65). Gestational age and birthweight were not associated with major morbidity. Of all survivors, 81% were discharged home without severe IVH, PVL or severe ROP.Conclusions: Increased survival as a result of active perinatal and neonatal management was associated with favourable morbidity rates compared with those in recent studies. Among survivors born at 23–25 weeks, neither gestational age nor birthweight was a significant determinant of major morbidity.
BMC Pregnancy and Childbirth, 2016
Background: To investigate perinatal decision-making and the use of obstetric interventions, we examined the effects of antenatal steroids, tocolysis, and delivery mode on birth in a good condition (defined as presence of an infant heart rate >100 at five minutes of age) and delivery-room (DR) death in extremely preterm deliveries. Methods: Prospective cohort of all singleton births in England in 2006 at 22-26 weeks of gestation where the fetus was alive at the start of labour monitoring or decision to perform caesarean section. Odds ratios adjusted for potential confounders (aOR) were calculated using logistic regression. Results: One thousand seven hundred twenty two singleton pregnancies were included. 1231 women received antenatal steroids, 437 tocolysis and 356 delivered by Caesarean section. In babies born vaginally, aOR between a partial course of steroids and improved condition at birth was 1.84, 95% CI: 1.20 to 2.82 and, for a complete course, 1.63, 95% CI: 1.08 to 2.47; for DR death, aORs were 0.34 (0.21 to 0.55) and 0.41 (0.26 to 0.64) for partial and complete courses of steroids. No association was seen for steroid use in babies delivered by Caesarean section. Tocolysis was associated with improved condition at birth (aOR 1.45, 95% CI: 1.05 to 2.0) and lower odds of death (aOR 0.48, 95% CI: 0.32 to 0.73). In women without spontaneous labour, Caesarean delivery at ≤ 24 and 25 weeks was associated with improved condition at birth ((aORs 12.67 (2.79 to 57.60) and 4.94 (1.44 to 16.90), respectively) and lower odds of DR death (aORs 0.03 (0.01 to 0.21) and 0.13 (0.03 to 0.55)). There were no differences at 26 weeks gestation or in women with spontaneous labour. Conclusions: Antenatal steroids are strongly associated with improved outcomes in babies born vaginally. Tocolysis was associated with improvements in all analyses. Effects persisted after adjustment for perinatal decision-making. However, associations between delivery mode and birth outcomes may be attributable to case selection.
Preterm birth: seven-year retrospective study in a single centre population
Italian Journal of Pediatrics
Background: Preterm birth is a health and social problem, considered the leading cause of neonatal mortality worldwide. It is associated with higher rates of neurodevelopmental morbidity, sensorineural impairments and other complications. The aim of the study was to describe the incidence and the major risk factors associated with preterm birth. Methods: We performed a single center, observational and retrospective Cohort study in the Division of Obstetrics and Gynaecology, University Hospital "G. Martino", Messina. Clinical records of all pregnant women who delivered from 1st January 2010 to 31 of December 2016 were collected. Results: In the 7 years considered, a total of 7954 pregnant women were included in our study. The majority of all preterm births were due to infants born late preterm (71.83%), 26.45% were due to preterm and 1.72% to extremely preterm. The preterm cohort had a higher proportion of history of preterm delivery (p < 0.0001), and unmarried (p = 0.003) and underweight or obese patients (p < 0.0001). In addition, prematurity was associated with presence of uterine anomalies (p < 0.0001), vaginal/urinary infections (p = 0.02), poli/oligohydramnios (p < 0.0001), maternal diabetes (p = 0.004), hypertension (p < 0.0001), short cervical length (p < 0.0001). Conclusions: We suggest prompt identification of all risk factors associated with preterm birth to apply immediate and appropriate specific interventions.
Preterm Delivery; Who Is at Risk?
Journal of Clinical Medicine
Preterm birth (PTB) is the leading cause of perinatal morbidity and mortality. Adverse effects of preterm birth have a direct correlation with the degree of prematurity, in which infants who are born extremely preterm (24–28 weeks gestation) have the worst outcomes. We sought to determine prominent risk factors for extreme PTB and whether these factors varied between various sub-populations with known risk factors such as previous PTB and multiple gestations. A population-based retrospective cohort study was conducted. Risk factors were examined in cases of extreme PTB in the general population, as well as various sub-groups: singleton and multiple gestations, women with a previous PTB, and women with indicated or induced PTB. A total of 334,415 deliveries were included, of which 1155 (0.35%) were in the extreme PTB group. Placenta previa (OR = 5.8, 95%CI 4.14–8.34, p < 0.001), multiple gestations (OR = 7.7, 95% CI 6.58–9.04, p < 0.001), and placental abruption (OR = 20.6, 95%...
The Comparison of the Risk Factors in the Term and Preterm Delivery
Journal of Babol University of Medical Sciences, 2015
BACKGROUND AND OBJECTIVE: Premature delivery is the presence of progressive uterine contractions before reaching 37 weeks of pregnancy. Since it is associated with perinatal complications and high costs, this study aimed to study the risk factors for premature delivery. METHODS: This cross-sectional study was conducted on 377 pregnant women with preterm labor (23-37 weeks) and 423 pregnant women of term delivery referring to Ayatollah Rohani Hospital of Babol city, Iran. We extracted and investigated the subjects’ demographic data, history of infertility, smoking habits, use of drugs, fast food consumption, history or presence of maternal illnesses and surgery, Urinary Tract Infections (UTI), Oligohydramnios, intrauterine growth restriction (IUGR), embryonic anomalies, premature rupture of membranes, vaginal bleeding as well as the neonatal data. FINDINGS: As observed in the two groups of preterm and term delivery respectively, there was employment during pregnancy in 83 (22%) and 5...