Limor Besser1, Liat Sabag-Shaviv2, Maayan Yitshak-Sade3, Salvatore Andrea Mastrolia1,4, Danielle Landau5, Ruthy Beer-Weisel1, Vered Klaitman1, Neta Benshalom-Tirosh1, Moshe Mazor1, Offer Erez6. 1. a Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences , Ben Gurion University of the Negev , Be'er Sheva , Israel. 2. b School of Medicine, Faculty of Health Sciences , Ben Gurion University of the Negev , Be'er Sheva , Israel. 3. c Clinical Research Center , Soroka University Medical Center, Ben Gurion University of the Negev , Be'er Sheva , Israel. 4. d Department of Maternal Fetal Medicine , Fondazione MBBM, San Gerardo Hospital, Università degli Studi di Milano-Bicocca , Monza , Italy. 5. e Department of Neonatology, Faculty of Health Sciences , Soroka University Medical Center, Ben Gurion University of the Negev , Be'er Sheva , Israel. 6. f Maternity Department D and Obstetrical Day care Unit , Soroka University Medical Center, Ben Gurion University of the Negev , Be'er Sheva , Israel.
Abstract
Objective: In the last few decades, attention has been focused on morbidity and mortality associated with late preterm delivery (34-36 + 6/7 weeks), accounting for 60-70% of all preterm births. This study is aimed to determine (1) the prevalence of late preterm deliveries (spontaneous and medically indicated) in our population; and (2) the rate of neonatal morbidity and mortality as well as maternal complications associated with the different phenotypes of late preterm deliveries. Study design: This retrospective population-based cohort study, included 96,176 women who had 257,182 deliveries, occurred between 1988 and 2011, allocated into three groups: term (n = 242,286), spontaneous (n = 10,063), and medically indicated (n = 4833) late preterm deliveries. Results: (1) Medically indicated late preterm deliveries were associated with increased maternal morbidity, as well as neonatal morbidity and mortality, in comparison with other study groups (p < .01 for all comparisons); (2) medically indicated late preterm delivery was an independent risk factor for composite neonatal morbidity (low Apgar score at 5', seizures, asphyxia, acidosis) after adjustment for confounding factors (maternal age and ethnicity and neonatal gender) and stratification according to gestational age at delivery; and (3) the proportion of medically indicated late preterm deliveries affected the neonatal mortality rate. Below 35% of all late preterm deliveries, indicated late preterm birth were associated with a reduction in neonatal mortality; however, above this threshold medically indicated late preterm deliveries were associated with an increased risk for neonatal death. Conclusions: (1) Medically indicated late preterm deliveries were independently associated with adverse composite neonatal outcome; and (2) to benefit in term of neonatal outcome from the tool of medically indicated late preterm birth, their proportion should be kept below 35% of all late preterm deliveries, while exceeding this threshold increases the risk of neonatal mortality.
Objective: In the last few decades, attention has been focused on morbidity and mortality associated with late preterm delivery (34-36 + 6/7 weeks), accounting for 60-70% of all preterm births. This study is aimed to determine (1) the prevalence of late preterm deliveries (spontaneous and medically indicated) in our population; and (2) the rate of neonatal morbidity and mortality as well as maternal complications associated with the different phenotypes of late preterm deliveries. Study design: This retrospective population-based cohort study, included 96,176 women who had 257,182 deliveries, occurred between 1988 and 2011, allocated into three groups: term (n = 242,286), spontaneous (n = 10,063), and medically indicated (n = 4833) late preterm deliveries. Results: (1) Medically indicated late preterm deliveries were associated with increased maternal morbidity, as well as neonatal morbidity and mortality, in comparison with other study groups (p < .01 for all comparisons); (2) medically indicated late preterm delivery was an independent risk factor for composite neonatal morbidity (low Apgar score at 5', seizures, asphyxia, acidosis) after adjustment for confounding factors (maternal age and ethnicity and neonatal gender) and stratification according to gestational age at delivery; and (3) the proportion of medically indicated late preterm deliveries affected the neonatal mortality rate. Below 35% of all late preterm deliveries, indicated late preterm birth were associated with a reduction in neonatal mortality; however, above this threshold medically indicated late preterm deliveries were associated with an increased risk for neonatal death. Conclusions: (1) Medically indicated late preterm deliveries were independently associated with adverse composite neonatal outcome; and (2) to benefit in term of neonatal outcome from the tool of medically indicated late preterm birth, their proportion should be kept below 35% of all late preterm deliveries, while exceeding this threshold increases the risk of neonatal mortality.
Authors: Chang Chen; Jin Wen Zhang; Hong Wei Xia; Hui Xin Zhang; Ana Pilar Betran; Lin Zhang; Xiao Lin Hua; Li Ping Feng; Dan Chen; Kang Sun; Chun Ming Guo; Hong Bo Qi; Tao Duan; Jun Zhang Journal: Am J Public Health Date: 2019-09-19 Impact factor: 9.308