The Canadian Perinatal Network: A National Network Focused on Threatened Preterm Birth at 22 to 28 Weeks’ Gestation

Magee, Laura A.; Dadelszen, Peter von; Allen, Victoria M.; Ansermino, J. Mark; Audibert, François; Barrett, Jon; Brant, Rollin; Bujold, Emmanuel; Crane, Joan; Demianczuk, Nestor; Joseph, K.S.; Lee, Shoo K.; Piedboeuf, Bruno; Smith, Graeme N.; Synnes, Anne; Walker, Mark; Whittle, Wendy; Wood, Stephen L.; Lee, Tang; Li, Jing; Payne, Beth; Liston, Robert

doi:10.1016/s1701-2163(16)34795-8

Cited by 10 publications

(9 citation statements)

References 12 publications

(14 reference statements)

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“…CPN details including data definitions have been published previously [25]. Ethics approval was obtained centrally as a quality assurance project by the Research Ethics Boards at the University of British Columbia (H05–70359) and at each study site.…”

Section: Methodsmentioning

confidence: 99%

Timing of delivery in a high-risk obstetric population: a clinical prediction model

Silva

Lisonkova

Dadelszen

et al. 2017

BMC Pregnancy Childbirth

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BackgroundThe efficacy of antenatal corticosteroid treatment for women with threatened preterm birth depends on timely administration within 7 days before delivery. We modelled the probability of delivery within 7 days of admission to hospital among women presenting with threatened preterm birth, using routinely collected clinical characteristics.MethodsData from the Canadian Perinatal Network (CPN) were used, 2005–11, including women admitted to hospital with preterm labour, preterm pre-labour rupture of membranes, short cervix without contractions, or dilated cervix or prolapsed membranes without contractions at preterm gestation. Women with fetal anomaly, intrauterine fetal demise, twin-to-twin transfusion syndrome, and quadruplets were excluded. Logistic regression was undertaken to create a predictive model that was assessed for its calibration capacity, stratification ability, and classification accuracy (ROC curve).ResultsWe included 3012 women admitted at 24–28 weeks gestation, or readmitted at up to 34 weeks gestation, to 16 tertiary-care CPN hospitals. Of these, 1473 (48.9%) delivered within 7 days of admission. Significant predictors of early delivery included maternal age, parity, gestational age at admission, smoking, preterm labour, prolapsed membranes, preterm pre-labour rupture of membranes, and antepartum haemorrhage. The area under the ROC curve was 0.724 (95% CI 0.706–0.742).ConclusionWe propose a useful tool to improve prediction of delivery within 7 days after admission among women with threatened preterm birth. This information is important for optimal corticosteroid treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1390-9) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Timing of delivery in a high-risk obstetric population: a clinical prediction model

Silva

Lisonkova

Dadelszen

et al. 2017

BMC Pregnancy Childbirth

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“…46 The mandate of the CPN is to focus on the maternal and perinatal outcomes and the optimal management of threatened very preterm birth at 22+0 weeks to 28+6 weeks of gestation. The CPN includes admissions to 16 of 23 tertiary perinatal units across Canada from August 1, 2005, to March 31, 2011.…”

Section: Methodsmentioning

confidence: 99%

Maternal and Perinatal Outcomes of Pregnancies Delivered at 23 Weeks’ Gestation

Crane

Magee

Lee

et al. 2015

Journal of Obstetrics and Gynaecology Canada

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Objective: To evaluate the maternal and perinatal outcomes of pregnancies delivered at 23+0 to 23+6 weeks' gestation .Methods: This prospective cohort study included women in the Canadian Perinatal Network who were admitted to one of 16 Canadian tertiary perinatal units between August 1, 2005, and March 31, 2011, and who delivered at 23+0 to 23+6 weeks' gestation . Women were included in the network if they were admitted with spontaneous preterm labour with contractions, a short cervix without contractions, prolapsing membranes with membranes at or beyond the external os or a dilated cervix, preterm premature rupture of membranes, intrauterine growth restriction, gestational hypertension, or antepartum hemorrhage . Maternal outcomes included Caesarean section, placental abruption, and serious complication . Perinatal outcomes were mortality and serious morbidity .Results: A total of 248 women and 287 infants were included in the study . The rate of Caesarean section was 10 .5% (26/248) and 40 .3% of women (100/248) had a serious complication, the most common being chorioamnionitis (38 .6%), followed by blood transfusion (4 .5% (25/25) . Two subgroup analyses were performed: in one, antepartum stillbirths were excluded, and in the other only centres that indicated they offered fetal monitoring at 23 weeks' gestation were included and antepartum stillbirths were excluded . In each of these, perinatal outcomes similar to the overall group were found . Conclusion:Pregnant women delivering at 23 weeks' gestation are at risk of morbidity . Their infants have high rates of serious morbidity and mortality . Further research is needed to identify strategies and forms of management that not only increase perinatal survival but also reduce morbidities in these extremely low gestational age infants and reduce maternal morbidity .

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“…could occur within 24 hours, but is not certain to), as there is no infallible way to identify all patients who will deliver within a given time period. Unpublished data gathered through the Canadian Perinatal Network suggest that only 24.4% of patients who present with indications such as preterm labour, antepartum hemorrhage, or premature prelabour rupture of the membranes deliver within 24 hours of admission to hospital [15]. As such, clinicians are likely to err by “overusing” magnesium sulphate among patients who present with threatened preterm birth.…”

Section: Methodsmentioning

confidence: 99%

“…Data from four RCTs were pooled to obtain these probabilities (Table 2) [8-11]. For the threatened preterm birth model (Figure 2), the probability of delivery within 24 hours of initiation of a single treatment with magnesium sulphate was estimated to be 0.2442 and the probability of re-treatment (given no delivery after an initial course of treatment) was estimated to be 0.6041 based on previously unpublished data from the Canadian Perinatal Network [15]. …”

Section: Methodsmentioning

confidence: 99%

Magnesium sulphate for fetal neuroprotection: a cost-effectiveness analysis

Bickford

Magee

Mitton

et al. 2013

BMC Health Serv Res

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BackgroundThe aim of this study was to assess the cost-effectiveness of administering magnesium sulphate to patients in whom preterm birth at < 32+0 weeks gestation is either imminent or threatened for the purpose of fetal neuroprotection.MethodsMultiple decision tree models and probabilistic sensitivity analyses were used to compare the administration of magnesium sulphate with the alternative of no treatment. Two separate cost perspectives were utilized in this series of analyses: a health system and a societal perspective. In addition, two separate measures of effectiveness were utilized: cases of cerebral palsy (CP) averted and quality-adjusted life years (QALYs).ResultsFrom a health system and a societal perspective, respectively, a savings of $2,242 and $112,602 is obtained for each QALY gained and a savings of $30,942 and $1,554,198 is obtained for each case of CP averted when magnesium sulphate is administered to patients in whom preterm birth is imminent. From a health system perspective and a societal perspective, respectively, a cost of $2,083 is incurred and a savings of $108,277 is obtained for each QALY gained and a cost of $28,755 is incurred and a savings of $1,494,500 is obtained for each case of CP averted when magnesium sulphate is administered to patients in whom preterm birth is threatened.ConclusionsAdministration of magnesium sulphate to patients in whom preterm birth is imminent is a dominant (i.e. cost-effective) strategy, no matter what cost perspective or measure of effectiveness is used. Administration of magnesium sulphate to patients in whom preterm birth is threatened is a dominant strategy from a societal perspective and is very likely to be cost-effective from a health system perspective.

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The Canadian Perinatal Network: A National Network Focused on Threatened Preterm Birth at 22 to 28 Weeks’ Gestation

Cited by 10 publications

References 12 publications

Timing of delivery in a high-risk obstetric population: a clinical prediction model

Timing of delivery in a high-risk obstetric population: a clinical prediction model

Maternal and Perinatal Outcomes of Pregnancies Delivered at 23 Weeks’ Gestation

Magnesium sulphate for fetal neuroprotection: a cost-effectiveness analysis

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