Objective: To examine hospital readmissions for premature infants during the first year of life.Study Design: The California maternal and newborn/infant hospital discharge records were examined for subsequent readmission during the first year of life for all newborns from 1992 to 2000. Discharge diagnoses, hospital days, demographic data and hospital charges for infants born preterm (<36 weeks gestation) were identified and evaluated.Result: About 15% of preterm infants required at least one rehospitalization within the first year of life (average cost per readmission $8468, average annual cost in excess of $41 million). Infants with gestational age <25 weeks had the highest rate of readmission (31%) and longest average length of stay (12 hospital days). The largest cohort, infants born at 35 weeks gestation, had the highest total cost of readmission ($92.9 million). The most common cause of rehospitalization was acute respiratory disease. There was no decrease in the number or cost of readmissions of premature infants for respiratory syncytial virus infections following the introduction of palivizumab in 1998. Conclusion:After initial discharge, premature infants continue to have significant in-patient health-care needs and costs.

Objective To compare perinatal outcomes between elective induction of labor (eIOL) and expectant management in obese women. Design Retrospective cohort study. Setting Deliveries in California in 2007. Population Term, singleton, vertex, nonanomalous deliveries among obese women (n=74,725). Methods Women who underwent eIOL at 37 weeks were compared with women who were expectantly managed at that gestational age. Similar comparisons were made at 38, 39, and 40 weeks. Results were stratified by parity. Chi-square tests and multivariable logistic regression were used for statistical comparison. Main Outcome Measures Method of delivery, severe perineal lacerations, postpartum hemorrhage, chorioamnionitis, macrosomia, shoulder dystocia, brachial plexus injury, respiratory distress syndrome. Results The odds of cesarean delivery were lower among nulliparous women with eIOL at 37 weeks (odds ratio [OR] 0.55, 95% confidence interval [CI] 0.34–0.90) and 39 weeks (OR 0.77, 95% CI 0.63–0.95) compared to expectant management. Among multiparous women with a prior vaginal delivery, eIOL at 37 (OR 0.39, 95% CI 0.24–0.64), 38 (OR 0.65, 95% CI 0.51–0.82), and 39 weeks (OR 0.67, 95% CI 0.56–0.81) was associated with lower odds of cesarean. Additionally, eIOL at 38, 39, and 40 weeks was associated with lower odds of macrosomia. There were no differences in the odds of operative vaginal delivery, lacerations, brachial plexus injury, or respiratory distress syndrome. Conclusions In obese women, term eIOL may decrease the risk of cesarean delivery, particularly in multiparas, without increasing the risks of other adverse outcomes when compared with expectant management. Tweetable Abstract Elective induction of labor in obese women does not increase risk of cesarean or other perinatal morbidities.

No abstract

The consequences of preterm birth (PTB), to the individual and society at large, remain a major financial and personal burden. Babies born at the limits of viability, who survive, often have major neurological impairments, such as cerebral palsy, developmental delay and blindness. The cost of initial hospitalisation is more than $200 000 for each birth but takes no account of future costs once they leave the hospital. The major morbidities associated with extreme prematurity are respiratory distress syndrome (RDS), intraventricular haemorrhage (IVH) and necrotising enterocolitis (NEC). With advancing gestational age at birth, the financial costs and morbidity associated with these conditions decrease. The major morbidities (RDS, IVH and NEC) are rare by 34 weeks of gestation, with the exception of RDS, which complicates 7% of deliveries at this gestational age. While the vast majority of infants survive the first year of life, the infant mortality rate is markedly increased by three‐ to five‐fold even for the mildly preterm infants, as compared with that of the term infants. Neonates born after 34 completed weeks of gestation rarely have mortality or major morbidity, but the financial costs remain significant ($7000 per case), and efforts to prevent delivery at this gestational age are probably indicated. Economic costs associated with PTB include the cost of initial hospitalisation, the cost of any chronic diseases resulting from the prematurity and social costs including loss of gainful employment by a family member taking care of the infant or child and loss of potential future earnings of the affected child. Antenatal steroids, if given to the mother at least 48 hours prior to a PTB, have shown significant reductions in RDS, IVH and NEC. Efforts to prevent, or avoid, PTB include the use of tocolytic agents which have been shown to prolong gestation for a minimum of 48 hours, or longer in some cases. The range of tocolytic agents used to delay or prevent PTB work through many different pathways, with varying degrees of success. Which tocolytic agent to use depends on many factors including underlying maternal status, gestational age of the fetus and documented efficacy of agent used.

The longer 3D cervical measurements may reflect the inability to measure the cervix adequately with 2D imaging, owing to anatomical factors. This finding may be useful in improving the predictive value of transvaginal ultrasound in assessing the risk for preterm delivery.