The Influence of Obstetric Practices on Late Prematurity
Section snippets
Management of pregnancy complications: general principles
When complications arise in pregnancy, physicians must assess the risks for continuing the pregnancy with the risks associated with immediate delivery. Preterm birth—whether spontaneous or indicated—carries with it the risk for significant neonatal morbidity and mortality. Accordingly, certain complications are expectantly managed with the goal of allowing the pregnancy to continue to a more advanced gestational age at which delivery carries less risk for prematurity-related morbidity to the
Spontaneous preterm labor
Preterm labor (PTL)—defined as regular uterine contractions leading to progressive cervical dilation before 37 weeks of gestation—is the most common cause of antepartum admission [14] and precedes up to 50% of preterm births [15]. Among late preterm births, spontaneous PTL accounts for a similar proportion of deliveries. In a recent study by McIntire and Leveno [16], approximately 45% of late preterm births at a single institution were attributed to idiopathic PTL. National data suggest that
Hypertensive disorders: gestational hypertension and preeclampsia
Hypertensive disorders are the most common medical complication of pregnancy and are estimated to affect 6% to 10% of all pregnancies [30]. Gestational hypertension (gHTN) is diagnosed as new finding of a systolic blood pressure (BP) of at least 140 mm Hg or a diastolic BP of at least 90 mm Hg on at least two occasions at least 6 hours apart after the 20th week of gestation in women known to be previously normotensive. Preeclampsia (PEC) is defined as the finding of hypertension with new-onset
Intrauterine growth restriction
IUGR is classically defined as a fetus with an estimated fetal weight decreasing lower than the 10th percentile for the given gestational age [52]. Although many fetuses with estimated weights at less than the 10th percentile are simple constitutionally small fetuses at the lower end of the normal growth spectrum, some fetuses measure lower than the 10th percentile because of suboptimal intrauterine growth. Maternal factors associated with IUGR include coexisting medical disorders
Summary
Although evidence of worsening maternal or fetal status clearly justifies iatrogenic late preterm delivery, many current obstetric practice guidelines routinely suggest delivery between 34 and 37 weeks. Given the increasing rate of late preterm birth and the increased recognition of the morbidity and mortality associated with delivery between 34 and 37 weeks, these standard obstetric practices and practice patterns leading to late preterm birth should be critically evaluated. The possibility of
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Cited by (44)
Neurodevelopmental Outcomes in Early Childhood
2018, Clinics in PerinatologyLate preterm births: An important issue but often neglected
2014, Taiwanese Journal of Obstetrics and GynecologyThe association between obstetrical interventions and late preterm birth
2014, American Journal of Obstetrics and GynecologyCitation Excerpt :A recent multicountry analysis that aimed to understand the main drivers for the increase in the preterm birth rate over time identified that cesarean section and labor induction together accounted for approximately 20% of the change in LP birth between 1989 and 2004.19 However, maternal and fetal health problems are also increasing and expedited delivery through obstetric intervention in the setting of maternal or fetal compromise is generally accepted practice to avoid potentially disastrous maternal or neonatal outcomes.20 Overall rates of stillbirth and perinatal death in the US have decreased in parallel to the increase in LP births prompting some to argue that obstetric intervention may be preventing stillbirth and perinatal death.21,22
Late prematurity: A systematic review
2014, Jornal de PediatriaCitation Excerpt :In practice, newborns with GA of 34 to 36 weeks and six days tend to be considered, both by obstetricians and neonatologists, as having a very similar risk to those born at term. This attitude is reflected in the obstetrician's routine, for instance, regarding the greater tolerance toward interrupting the pregnancy when there are maternal and/or fetal complications from 34 weeks on,1 as well as in the neonatologist's routine, regarding the tendency to keep these newborns in low-risk nurseries or rooming-in care2 and provide early discharge.3 These practices are due, at least in part, to results of studies by Goldenberg et al.4 and by De Palma et al.5 These authors evaluated the gain for each additional week of gestation between 22 and 37 weeks in increased survival and decreased risk of complications and/or sequelae.
Antenatal corticosteroid therapy and late preterm infant morbidity and mortality
2014, Anales de Pediatria