Risks of stillbirth, neonatal mortality, and severe neonatal morbidity by birthweight centiles associated with expectant management at term

Hong, Jesrine Gek Shan; Crawford, Kylie; Odibo, Anthony O.; Turner, Jessica

doi:10.1016/j.ajog.2023.04.044

Cited by 2 publications

(2 citation statements)

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“…However, planned delivery, even at late preterm and early term gestation, needs to be balanced against the increased neonatal and neurodevelopmental hazards of delivery at these gestations 44 . Our findings in this study, as well as from others 45 , may help reassure clinicians that it is reasonable to prolong the pregnancy if there is no additional concern about fetal wellbeing (e.g. abnormal fetal Doppler or amniotic fluid volume).…”

Section: Discussionsupporting

confidence: 72%

Assessment of fetal growth trajectory identifies infants at high risk of perinatal mortality

Larsen,

Krebs,

Hoei‐Hansen

et al. 2024

Ultrasound in Obstet & Gyne

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ObjectiveTo analyze perinatal risks associated with three distinct scenarios of fetal growth trajectory in the latter half of pregnancy compared with a referent group.MethodsThis cohort study included women with singleton pregnancies that birthed between 32+0 and 41+6 gestational weeks and had two or more ultrasound scans at least four weeks apart from 18+0 weeks. We evaluated three different scenarios of fetal growth against a referent, defined as appropriate for gestational age‐sized fetuses with appropriate forward growth trajectories. The comparator growth trajectories were categorized as Group 1: Small for gestational age (SGA) fetuses (EFW or AC <10th centile) with appropriate forward growth; Group 2: Decreased growth trajectory fetuses (decrease of ≥50 centiles) with EFW or AC ≥10th centile (i.e., non‐SGA) at their final scan; and Group 3: Decreased growth trajectory fetuses with EFW or AC <10th centile (i.e., SGA) at their final scan. The primary outcomes were perinatal mortality (stillbirth or neonatal death). Secondary outcomes included stillbirth, birth of an SGA infant, preterm birth, emergency cesarean section (CS) for non‐reassuring fetal status (NRFS), and composite severe neonatal morbidity. Associations were analyzed using logistic regression.ResultsThe final study cohort comprised 5319 pregnancies. Compared to the referent group, the adjusted odds of perinatal mortality were significantly increased in Group 2 (odds ratio [OR] 4.00, 95%CI 1.36–11.22) and Group 3 (OR 7.71, 95%CI 2.39–24.91). Only Group 3 had increased odds of stillbirth (OR 5.69, 95%CI 1.55–20.93). In contrast, infants in Group 1 did not have significantly increased odds of demise. The odds of an SGA infant at birth increased in all three groups but were highest in Group 1 (OR 111.86, 95%CI 62.58–199.95) and Group 3 (OR 40.63, 95%CI 29.01–56.92). In both groups, more than 80% of infants were born SGA, and nearly half had a birth weight <3rd centile. Likewise, the odds of preterm birth were increased in all three groups, being the highest in Group 3 with an OR of 4.27 (3.23–5.64). Lastly, the odds of severe neonatal morbidity were increased in Groups 1 and 3, whereas the odds of emergency CS for NRFS were only increased in Group 3.ConclusionsAssessing the fetal growth trajectory in the latter half of pregnancy can help identify infants at increased risk of perinatal mortality and birth weight <3rd centile for gestation.This article is protected by copyright. All rights reserved.

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Section: Discussionsupporting

confidence: 72%

Assessment of fetal growth trajectory identifies infants at high risk of perinatal mortality

Larsen,

Krebs,

Hoei‐Hansen

et al. 2024

Ultrasound in Obstet & Gyne

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show abstract

“…In term infants, the risk of neonatal and infant death decreases with increasing gestational age, however, infants born at early term gestation (37 +0 –38 +6 weeks) have a greater risk of severe neonatal morbidity, 14 increased rates of hospital admission during childhood 14 , 15 and poorer long-term neurodevelopmental outcomes 16 compared to full-term infants. 17 There is however limited information regarding the association between the 5-min Apgar score and severe neonatal outcomes stratified by gestational age in term infants.…”

Section: Introductionmentioning

confidence: 99%

Five-minute Apgar score and risk of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity in term infants – an Australian population-based cohort study

Hong,

Crawford,

Jarrett

et al. 2024

The Lancet Regional Health - Western Pacific

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Risks of stillbirth, neonatal mortality, and severe neonatal morbidity by birthweight centiles associated with expectant management at term

Cited by 2 publications

References 50 publications

Assessment of fetal growth trajectory identifies infants at high risk of perinatal mortality

Assessment of fetal growth trajectory identifies infants at high risk of perinatal mortality

Five-minute Apgar score and risk of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity in term infants – an Australian population-based cohort study

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