Cande V Ananth1, Anthony M Vintzileos. 1. Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, 08901-1977, USA. cande.ananth@umdnj.edu
Abstract
OBJECTIVE: We sought to examine the extent to which a temporal increase in preterm cesarean delivery is associated with gestational age-specific changes in perinatal survival in preterm gestations. STUDY DESIGN: We utilized data on singleton births in the United States (1990 through 2004) delivered between 24-36 weeks' gestation. Associations between changes in cesarean delivery at preterm gestations and trends in the risk of preterm stillbirth, and neonatal and perinatal mortality were estimated before and after adjustments for a variety of potential confounders. RESULTS: From 1990 through 2004, cesarean delivery rates increased by 50.6%, 40.7%, and 35.8% at 24-27, 28-33, and 34-36 weeks, respectively. The largest incremental effect of cesarean was associated with a reduction in stillbirths by 5.8%, 14.2%, and 23.1% at 24-27, 28-33, and 34-36 weeks, respectively, leading to an 11.4%, 4.9%, and 0.6% reduction in perinatal deaths at 24-27, 28-33, and 34-36 weeks, respectively. CONCLUSION: Increasing rates of preterm cesarean were associated with improved perinatal survival. This association was evident largely because of dramatic incremental declines in stillbirths.
OBJECTIVE: We sought to examine the extent to which a temporal increase in preterm cesarean delivery is associated with gestational age-specific changes in perinatal survival in preterm gestations. STUDY DESIGN: We utilized data on singleton births in the United States (1990 through 2004) delivered between 24-36 weeks' gestation. Associations between changes in cesarean delivery at preterm gestations and trends in the risk of preterm stillbirth, and neonatal and perinatal mortality were estimated before and after adjustments for a variety of potential confounders. RESULTS: From 1990 through 2004, cesarean delivery rates increased by 50.6%, 40.7%, and 35.8% at 24-27, 28-33, and 34-36 weeks, respectively. The largest incremental effect of cesarean was associated with a reduction in stillbirths by 5.8%, 14.2%, and 23.1% at 24-27, 28-33, and 34-36 weeks, respectively, leading to an 11.4%, 4.9%, and 0.6% reduction in perinatal deaths at 24-27, 28-33, and 34-36 weeks, respectively. CONCLUSION: Increasing rates of preterm cesarean were associated with improved perinatal survival. This association was evident largely because of dramatic incremental declines in stillbirths.
Authors: Cande V Ananth; Alexander M Friedman; Katherine M Keyes; Jessica A Lavery; Ava Hamilton; Jason D Wright Journal: Epidemiology Date: 2017-07 Impact factor: 4.822
Authors: Ahmad Moosavi; Sepideh Gareh Sheikhlou; Sara Gareh Sheikhlou; Kolsum Abdolahi; Leila Yaminifar; Maryam Maktabi Journal: Electron Physician Date: 2017-04-25