Maternal and neonatal outcomes by labor onset type and gestational age

Abstract

OBJECTIVE-We sought to determine maternal and neonatal outcomes by labor onset type and gestational age.STUDY DESIGN-We used electronic medical records data from 10 US institutions in the Consortium on Safe Labor on 115,528 deliveries from 2002 through 2008. Deliveries were divided by labor onset type (spontaneous, elective induction, indicated induction, unlabored cesarean). Neonatal and maternal outcomes were calculated by labor onset type and gestational age.RESULTS-Neonatal intensive care unit admissions and sepsis improved with each week of gestational age until 39 weeks (P < .001). After adjusting for complications, elective induction of labor was associated with a lower risk of ventilator use (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.28 -0.53), sepsis (OR, 0.36; 95% CI,, and neonatal intensive care unit admissions (OR, 0.52; 95% CI, 0.48 -0.57) compared to spontaneous labor. The relative risk of hysterectomy at term was 3.21 (95% CI, 1.08 -9.54) with elective induction, 1.16 (95% CI, 0.24 -5.58) with indicated induction, and 6.57 (95% CI, 1.78 -24.30) with cesarean without labor compared to spontaneous labor.Presented orally at the 30th Annual Meeting of the Society for Maternal-Fetal Medicine, Chicago, IL, Feb. 1-6, 2010. The racing flag logo above indicates that this article was rushed to press for the benefit of the scientific community.Reprints not available from the authors. NIH Public Access Author ManuscriptAm J Obstet Gynecol. Author manuscript; available in PMC 2011 March 1. Over the last few years, evidence for poorer neonatal outcomes at <39 weeks has been published. [2][3][4][5] In light of these data, clinicians should counsel patients on the increased risks to the neonate of a scheduled delivery <39 weeks. However, with few data available, it has been difficult to counsel patients about the maternal risks of elective induction in comparison to other labor onset types.The studies on early term neonatal outcomes have been from single centers or used administrative data that lacked some clinical detail. Tita et al 4 published a nationally representative multicenter study based on abstracted medical records. That study showed neonatal outcomes were worse in babies delivered <39 weeks, but it only looked at repeat cesarean deliveries.The Consortium on Safe Labor is a National Institutes of Health multicenter collaborative study designed to characterize labor and delivery in a contemporary group of women experiencing current obstetric clinical practices. By design, study hospitals had to have obstetric electronic medical records (EMR) that coded data into prespecified fields that would allow for data to be abstracted and combined into a uniform dataset for subsequent analysis of patient-specific risk factors and maternal and neonatal outcomes. Unlike electronic administrative data, EMRs are a direct clinical source and are rich in clinical and demographic details. These data offer the advantages of a large national sample size while maintaining the clinical detail of a single...

Maternal request: a reason for rising rates of cesarean section?

“…One patient underwent hysterectomy due to otherwise uncontrollable PPH. The higher risk of maternal complications, especially regarding blood loss, hysterectomy, and pain due to CS in general as well as elective CS in particular has been noted in several studies [25,26]. There is also evidence for higher neonatal risks due to elective CS.…”

Morbilidade Neonatal e Cesariana Electiva em Recém-Nascidos de Termo

“…No nosso estudo 95,3% (1 361/1 427) dos RN com IG inferior a 39 semanas pesava mais de 2 500 gramas. Mas sabe-se que estes RN são fisiologicamente imaturos e quando comparados com os RN de IG igual ou superior a 39 semanas têm maior necessidade de internamento na UCIN [13][14][15]17,19 como também verificamos neste estudo.…”

“…Recentemente houve também uma chamada de atenção para os 'RN termo precoce' (37 0 S -38 6 S) que quando comparados com RN com idade gestacional (IG) superior ou igual a 39 semanas apresentam maior mortalidade 9-12 e morbilidade neonatal. [10][11][12][13][14][15][16][17][18][19] Os partos eletivos, incluindo a cesariana eletiva, têm aumentado por diferentes razões em todo o mundo, [11][12][13][14] havendo um grande número de cesarianas eletivas por razões não médicas antes das 39 semanas. O ACOG publicou um boletim sobre esta temática, o Committee Opinion Nº 579, que desaconselha a indução por razões não médicas antes das 39 semanas.…”

Late Preterm and Early Term Neonates: A New Group of High Risk Newborn in Neonatology with Varied Complications

“…When the late preterm and early term infants are compared with those born before 34 weeks of gestation, these infants are at lower risks for numerous medical problems, but, compared with those born at 39 and 40 weeks' gestation, they are at higher risks for various morbidity and mortality [43][44][45]. There are many field of investigation and research including cardiovascular and pulmonary systems, nervous system, metabolic, nutrition, breastfeeding and lactation, immunology and sepsis, renal and genitourinary systems, development pharmacology [46,47].…”