The risk of intrauterine fetal death in the small-for-gestational-age fetus
We sought to evaluate the risk of intrauterine fetal death (IUFD) in small-for-gestational-age (SGA) fetuses. We analyzed a retrospective cohort of all births in the United States in 2005, as recorded in a national database. We calculated the risk of IUFD within 3 sets of SGA threshold categories as well as within non-SGA pregnancies using the number of at-risk fetuses as the denominator. The risk of IUFD increased with gestational age and was inversely proportional to percentile of birthweight for gestational age. The risk for IUFD in those <3rd percentile was as high as 58.0 IUFDs per 10,000 at-risk fetuses, 43.9 for <5th percentile, and 26.3 for <10th percentile compared to 5.1 for non-SGA gestations. There is an increase in the risk of IUFD in SGA fetuses compared to non-SGA fetuses at all gestational ages with the greatest risk demonstrated in the lowest percentile cohort evaluated.
[Show abstract] [Hide abstract] ABSTRACT: Study question: To determine whether the umbilical cord insertion site of singleton pregnancies could be linked to the newborn birth weight at term and its individual growth potential achievement. Material and methods: A cohort study including 528 records of term neonates was performed. Each neonate was assessed for growth adjusted for gestational age according to the infant's growth potential using the AUDIPOG module. We considered two categories of umbilical cord insertions: central and peripheral. Intrauterine growth restriction was defined as birth weight below the 10th percentile. Statistical analysis was performed using Chi-square, Student's t test, Wilcoxon test, ANOVA, and logistic regression. Results: We observed a total of 343 centrally inserted cords versus 185 peripheral cords. There were twice as many smokers in the mothers of the peripheral category compared to the centrally inserted ones. More importantly, we demonstrated that only 17/343 (5.0%) of infants with central cord insertion were growth restricted, compared to 37/185 (20.0%) of the infants born with a peripheral insertion. Neonates with centrally inserted cord were significantly heavier. Conclusion: The umbilical cord insertion site of singleton pregnancies is associated with the newborn's birth weight at term and its individual growth potential achievement.0Comments 0Citations
- "Types of placentas Central Peripheral Paracentral Battledore Velamentous Number (%) 343/528 (65.0) 136/528 (25.8) 44/528 (8.3) 5/528 (0.95) 95% CI [60–70] [21–33] [5–16]           "
[Show abstract] [Hide abstract] ABSTRACT: Guidelines recommend that, in the absence of compelling medical indications (low risk) elective caesarean section should occur after 38 completed weeks gestation. However, implementation of these guidelines will mean some women go into labour before the planned date resulting in an intrapartum caesarean section. The aim of this study was to determine the rate at which low-risk women planned for repeat caesarean section go into spontaneous labour before 39 weeks. We conducted a population-based cohort study of women who were planned to have an elective repeat caesarean section (ERCS) at 39-41 weeks gestation in New South Wales Australia, 2007-2010. Labour, delivery and health outcome information was obtained from linked birth and hospital records for the entire population. Women with no pre-existing medical or pregnancy complications were categorized as 'low risk'. The rate of spontaneous labour before 39 weeks was determined and variation in the rate for subgroups of women was examined using univariate and multivariate analysis. Of 32,934 women who had ERCS as the reported indication for caesarean section, 17,314 (52.6%) were categorised as 'low-risk'. Of these women, 1,473 (8.5% or 1 in 12) had spontaneous labour or prelabour rupture of the membranes before 39 weeks resulting in an intrapartum caesarean section. However the risk of labour <39 weeks varied depending on previous delivery history: 25% (1 in 4) for those with spontaneous preterm labour in a prior pregnancy; 15% (1 in 7) for women with a prior planned preterm birth (by labour induction or prelabour caesarean) and 6% (1 in 17) among those who had only previously had a planned caesarean section at term. Smoking in pregnancy was also associated with spontaneous labour. Women with spontaneous labour prior to a planned CS in the index pregnancy were at increased risk of out-of-hours delivery, and maternal and neonatal morbidity. These findings allow clinicians to more accurately determine the likelihood that a planned caesarean section may become an intrapartum caesarean section, and to advise their patients accordingly.0Comments 4Citations
- "The findings from this study are consistent with previous studies showing that at or close to term, the benefit of each increased week of gestation is greater than the respiratory benefit of fetal exposure to labour [2,32]. Each additional week of gestation does present some risk of intrauterine death, however for births where the infant is ≥10 th percentile for size the risk of intrauterine death at 37 and 38 weeks is less than 2 per 10,000 ongoing pregnancies . A natural consequence of spontaneous labour <39 weeks was the increase in 'out of hours' caesarean section and a tendency towards increased rates of general anaesthesia. "
[Show abstract] [Hide abstract] ABSTRACT: This study assessed the temporal stability of spatial patterns in the incidence of preterm and small-for-gestational-age (SGA) in regional Western Australia, from 1987 to 2006. Using a time-stratified design, we characterised spatial variation in the probability of preterm and SGA among 109 contiguous areas within each year, and compared spatial patterns between years. We also analysed spatial patterns based on all 20 years combined. In each instance, spatial variation was modelled by fitting a spatially-correlated random effect plus a spatially-uncorrelated random effect. We observed that spatial patterns were consistent over time. We demonstrated weak temporal autocorrelation and little evidence of anomalous years in the spatial patterns of preterm and SGA. Whereas the mean 20-year probability of preterm was 0.057 and the mean probability of SGA was 0.051, areas in the north of Western Australia had probabilities of 0.090 or more for both outcomes. Four areas in the far north of Western Australia were above the 90th centile of preterm for at least 14 of the 20 years, and above the 90th centile of SGA for at least 15 years. The consistency of spatial patterns over time and between birth outcomes strengthens the case for targeting high risk areas for improved outcomes. This study demonstrates how, even in the absence of a spatio-temporal interaction, incorporating the temporal dimension adds value to the spatial analysis of health data.0Comments 0Citations
- "Whereas SGA is commonly defined on the 10th centile of birthweight (Alexander et al., 1996), we used the narrower threshold of the 5th centile so that the mean prevalence of SGA was comparable to that of preterm (mean of 57 per 1000 in the study area), so that analyses of the two birth outcomes would share similar statistical power. Many previous studies have used the 5th centile of birthweight as an indicator of SGA (Abeysena, Jayawardana, & Seneviratne, 2009; Khashan, Baker, & Kenny, 2010; Pilliod, Cheng, Snowden, Doss, & Caughey, 2012; Zhang & Harville, 1998). As national centiles for SGA were unavailable for gestations prior to 24 completed weeks, all births before 24 weeks gestation were excluded. "