Nehama Linder1,2, Liran Hiersch2,3, Elana Fridman1, Gil Klinger2,4, Daniel Lubin1, Franck Kouadio1, Nir Melamed3. 1. Department of Neonatology, The Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel. 2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. Departments of Obstetrics and Gynecology, The Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel. 4. Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
Abstract
OBJECTIVE: To determine the independent association of post-term pregnancy with neonatal outcome in low-risk newborns. DESIGN: Retrospective cohort. SETTING: Tertiary university-affiliated medical centre. PATIENTS: All newborns of low-risk singleton pregnancies born at 39+0 to 44+0 weeks' gestation over a 5-year period. EXCLUSION CRITERIA: multiple gestation, maternal hypertensive disorder, diabetes or cholestasis, placental abruption or intrapartum fever (>38°C), small for gestational age (<10th centile) and major congenital or chromosomal anomalies. INTERVENTIONS: None. OUTCOME MEASURES: Admission to the neonatal intensive care unit (NICU), hospital length of stay, 5-min Apgar score, birth trauma, respiratory, neurological, metabolic and infectious morbidities and neonatal mortality. The adverse outcome rate was compared among three groups based on gestational age at birth: post-term (≥42+0 weeks), late term (41+0 to 41+6 weeks) and full term (39+0 to 40+6 weeks). RESULTS: Of the 23 524 eligible neonates, 747 (3.2%) were born post-term, 4632 (19.7%) late term and 18 145 (77.1%) full term. Women in the post-term group versus the late-term group had a significantly higher rate of caesarean section (8.9% vs 5.6%, p<0.001) and operative vaginal delivery (9.6% vs 7.4%, p=0.024). Post-term pregnancy versus full-term pregnancy was associated with an increased risk of NICU admission (OR 2.0, 95% CI 1.4 to 2.8), respiratory morbidity (OR 2.2, 95% CI 1.3 to 3.8) and infectious morbidity (OR 1.88, 95% CI 1.32 to 2.69). Post-term pregnancy versus late-term pregnancy was similarly associated with an increased risk of NICU admission (OR 2.0, 95% CI 1.4 to 2.9), respiratory morbidity (OR 2.7, 95% CI 1.5 to 5.0) and infectious morbidity (OR 1.8, 95% CI 1.2 to 2.7) and with hypoglycaemia (OR 2.6, 95% CI 1.2 to 5.4). Post-term delivery was not associated with neonatal mortality. CONCLUSIONS: Post-term pregnancy is an independent risk factor for neonatal morbidity even in low-risk singleton pregnancies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
OBJECTIVE: To determine the independent association of post-term pregnancy with neonatal outcome in low-risk newborns. DESIGN: Retrospective cohort. SETTING: Tertiary university-affiliated medical centre. PATIENTS: All newborns of low-risk singleton pregnancies born at 39+0 to 44+0 weeks' gestation over a 5-year period. EXCLUSION CRITERIA: multiple gestation, maternal hypertensive disorder, diabetes or cholestasis, placental abruption or intrapartum fever (>38°C), small for gestational age (<10th centile) and major congenital or chromosomal anomalies. INTERVENTIONS: None. OUTCOME MEASURES: Admission to the neonatal intensive care unit (NICU), hospital length of stay, 5-min Apgar score, birth trauma, respiratory, neurological, metabolic and infectious morbidities and neonatal mortality. The adverse outcome rate was compared among three groups based on gestational age at birth: post-term (≥42+0 weeks), late term (41+0 to 41+6 weeks) and full term (39+0 to 40+6 weeks). RESULTS: Of the 23 524 eligible neonates, 747 (3.2%) were born post-term, 4632 (19.7%) late term and 18 145 (77.1%) full term. Women in the post-term group versus the late-term group had a significantly higher rate of caesarean section (8.9% vs 5.6%, p<0.001) and operative vaginal delivery (9.6% vs 7.4%, p=0.024). Post-term pregnancy versus full-term pregnancy was associated with an increased risk of NICU admission (OR 2.0, 95% CI 1.4 to 2.8), respiratory morbidity (OR 2.2, 95% CI 1.3 to 3.8) and infectious morbidity (OR 1.88, 95% CI 1.32 to 2.69). Post-term pregnancy versus late-term pregnancy was similarly associated with an increased risk of NICU admission (OR 2.0, 95% CI 1.4 to 2.9), respiratory morbidity (OR 2.7, 95% CI 1.5 to 5.0) and infectious morbidity (OR 1.8, 95% CI 1.2 to 2.7) and with hypoglycaemia (OR 2.6, 95% CI 1.2 to 5.4). Post-term delivery was not associated with neonatal mortality. CONCLUSIONS: Post-term pregnancy is an independent risk factor for neonatal morbidity even in low-risk singleton pregnancies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
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