Article

Timing of Indicated Late-Preterm and Early-Term Birth

Columbia University, New York, New York, United States
Obstetrics and Gynecology (Impact Factor: 5.18). 08/2011; 118(2 Pt 1):323-33. DOI: 10.1097/AOG.0b013e3182255999
Source: PubMed

ABSTRACT

The growing public health awareness of prematurity and its complications has prompted careful evaluation of the timing of deliveries by clinicians and hospitals. Preterm birth is associated with significant morbidity and mortality, and affects more than half a million births in the United States each year. In some situations, however, a late-preterm or early-term birth is the optimal outcome for the mother, child, or both owing to conditions that can result in worse outcomes if pregnancy is allowed to continue. These conditions may be categorized as placental, maternal, or fetal, including conditions such as placenta previa, preeclampsia, and multiple gestations. Some risks associated with early delivery are common to all conditions, including prematurity-related morbidities (eg, respiratory distress syndrome and intraventricular hemorrhage) as well as maternal intrapartum morbidities such as failed induction and cesarean delivery. However, when continuation of the pregnancy is associated with more risks such as hemorrhage, uterine rupture, and stillbirth, preterm delivery maybe indicated. In February 2011, the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Society for Maternal-Fetal Medicine held a workshop titled "Timing of Indicated Late Preterm and Early Term Births." The goal of the workshop was to synthesize the available information regarding conditions that may result in medically indicated late-preterm and early-term births to determine the potential risks and benefits of delivery compared with continued pregnancy, determine the optimal gestational age for delivery of affected pregnancies when possible, and inform future research regarding these issues. Based on available data and expert opinion, optimal timing for delivery for specific conditions was determined by consensus.

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    • "Infants were excluded if their underlying diagnosis was consistent with a defect associated with abnormal nitric oxide levels or ciliary dysfunction. Late-preterm infants (defined as 34e37 weeks post-conceptual age) were enrolled, but infants born prior to 34 weeks post-conceptual age were excluded [20] "
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    ABSTRACT: Primary ciliary dyskinesia (PCD), a disease of impaired respiratory cilia motility, is often difficult to diagnose. Recent studies show low nasal nitric oxide (nNO) is closely linked to PCD, allowing the use of nNO measurement for PCD assessments. Nasal NO cutoff values for PCD are stratified by age, given nNO levels normally increase with age. However, normative values for nNO have not been established for infants less than 1 year old. In this study, we aim to establish normative values for nNO in infants and determine their utility in guiding infant PCD assessment. We obtained 42 nNO values from infants less than 1 year old without a history of PCD or recurrent sinopulmonary disease. Using regression analysis, we estimated the mean age-adjusted nNO values and established a 95% prediction interval (PI) for normal nNO. Using these findings, we were able to show 14 of 15 infant PCD patients had abnormally low nNO with values below the 95% PI. In this study we determined a regression model that best fits normative nNO values for infants less than 1 year old. This model identified the majority of PCD infants as having abnormally low nNO. These findings suggest nNO measurement can help guide PCD assessment in infants, and perhaps other pulmonary diseases with a link to low nNO. With early assessments, earlier clinical intervention may be possible to slow disease progression and help reduce pulmonary morbidity. Copyright © 2015 Elsevier Ltd. All rights reserved.
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    • "Some deliveries should occur prior to 39 weeks of gestation, and accurate documentation of medical, fetal, and obstetrical complications can facilitate appropriate timing of scheduled early deliveries, as well as appropriate reimbursement. In 2011 the National Institute of Child Health and Human Development and the Society for Maternal-Fetal Medicine held a workshop to synthesize the available information about conditions that may necessitate medically indicated late-preterm or early-term births, and an article was subsequently published outlining what was learned about the optimal timing of delivery for specific conditions[20]. That information can help clinicians and hospitals avoid the problems that can arise when efforts to avoid elective early-term deliveries have the unintended consequence of preventing medically indicated early-term deliveries; these problems are highlighted in a 2012 article by Clark and colleagues[21]. "

    Preview · Article · May 2014 · North Carolina medical journal
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    • "Furthermore, PTB can occur “early” (<34 weeks’ gestation) or “late” (34–36 weeks’ gestation). Pregnancy complications leading to medical inductions disproportionately contribute to late PTB, as compared to early PTB [6-8]. A recent systematic review of 84 studies demonstrated that prepregnancy obesity is associated with a 1.24-fold increased risk of PTB [9]. "
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    ABSTRACT: To evaluate the association between prepregnancy body mass index (BMI) is associated with early vs. late and medically-induced vs. spontaneous preterm birth (PTB) subtypes. Using data from the Boston Birth Cohort, we examined associations of prepregnancy BMI with 189 early (<34 completed weeks) and 277 late (34-36 completed weeks) medically-induced PTBs and 320 early and 610 late spontaneous PTBs vs. 3281 term births (37-44 weeks) in multinomial regression. To assess for mediation by important pregnancy complications, we performed sequential models with and without hypertensive disorders of pregnancy, chorioamnionitis, and gestational diabetes. Prevalence of prepregnancy obesity (BMI >= 30.0 kg/m2) was 28% among mothers with medically-induced PTBs, 18% among mothers with spontaneous PTBs, and 18% among mothers with term births (p = <0.001). After adjustment for demographic and known risk factors for PTB, prepregnancy obesity was associated with higher odds of both early [OR 1.78 (1.19, 2.66)] and late [OR 1.49 (1.09, 2.04)] medically-induced PTB. These effect estimates were attenuated with inclusion of hypertensive disorders of pregnancy and gestational diabetes. For spontaneous deliveries, prepregnancy obesity was associated with decreased odds of PTB (0.76 [0.58, 0.98]) and underweight was nearly associated with increased odds of PTB (1.46 [0.99, 2.16]). Prepregnancy obesity is associated with higher risk of medically-induced, but not spontaneous PTB. Hypertensive disorders of pregnancy and gestational diabetes appear to partially explain the association between prepregnancy obesity and early and late medically-induced PTB.
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