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A Late-Preterm, Early-Term Stratified Analysis of Neonatal Outcomes by Gestational Age in Placenta Previa: Defining the Optimal Timing for Delivery.
MedLine Citation:
PMID:  25283850     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Abstract Objective Though no official guidelines address the issue of the optimal timing of delivery in placenta previa, common practice is to conduct delivery between 36-37 weeks gestation. Given the rising concerns regarding unnecessary premature deliveries, the objective of this study was to compare neonatal outcomes amongst pregnancies complicated by placenta previa delivered at the late-preterm period (35, 36 weeks) relative to the early-term period (37, 38 weeks). Methods We conducted a retrospective, population-based, cohort study using the CDC's Linked Birth-Infant Death data files from the U.S. for the year 2004. We stratified the cohort according to gestational age and placenta previa status. Using 38 weeks gestation as reference controls, the effect of delivery in a pregnancy with placenta previa at 35, 36 and 37 weeks gestation on the risk of several neonatal outcomes was estimated using logistic regression analysis, adjusting for relevant confounders. Results We analyzed a total of 4,118,956 births, out of which 5,675 (0.1%) met inclusion criteria. Late-preterm delivery was associated with lower birthweight and increased adequacy of care. Relative to neonates born at 38 weeks, birth at 35, 36 and 37 weeks was associated with no greater odds of meconium passage, fetal distress, fetal anemia, neonatal seizures, increased ventilator needs, or infant death at one year. However, odds of 5-minute APGAR scores < 7 were greater at 35 and 36 weeks (aOR [95% CI]): 3.33 [1.71-6.47] and 2.17 [1.11-4.22], respectively; as were odds of NICU admission rates: 2.25 [2.01-2.50] and 1.57 [1.38-1.76], respectively. Conclusions: Barring maternal indications, early-term delivery in placenta previa is associated with fewer complications and no greater risk than late-preterm delivery. This information may be helpful in the development of future guidelines, which are currently needed to guide the management of these pregnancies.
Authors:
Jacques Balayla; Bi Lan Wo; Marie-Josée Bédard
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-10-6
Journal Detail:
Title:  The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians     Volume:  -     ISSN:  1476-4954     ISO Abbreviation:  J. Matern. Fetal. Neonatal. Med.     Publication Date:  2014 Oct 
Date Detail:
Created Date:  2014-10-6     Completed Date:  -     Revised Date:  2014-10-7    
Medline Journal Info:
Nlm Unique ID:  101136916     Medline TA:  J Matern Fetal Neonatal Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  1-20     Citation Subset:  -    
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