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Trends in obstetric practices and meconium aspiration syndrome: a population-based study.
MedLine Citation:
PMID:  21895951     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Please cite this paper as: Vivian-Taylor J, Sheng J, Hadfield R, Morris J, Bowen J, Roberts C. Trends in obstetric practices and meconium aspiration syndrome: a population-based study. BJOG 2011; DOI: 10.1111/j.1471-0528.2011.03093.x. Objective  To determine trends in the incidence of meconium aspiration syndrome (MAS), and maternal factors and obstetric practices associated with any decline. Design  Population-based cohort study. Setting  New South Wales (NSW), Australia. Population  All 877 037 liveborn, singleton, term infants (≥37 weeks of gestation) in the period 1997-2007. Methods  Data were obtained from birth records linked to the neonatal hospital discharge records. The birth data provided information on maternal and obstetric factors, whereas the outcome of interest, MAS, was obtained from hospital data on the neonates. Multivariable logistic regression was used to estimate the risk of MAS while simultaneously adjusting for the explanatory variables. Main outcome measures  The incidence of MAS per 1000 births, and odds ratios and 95% confidence intervals for maternal and obstetric factors for the development of MAS. Results  The incidence of MAS declined significantly by 11.3% per annum (95% CI 10.1-12.6; P < 0.001) from 4.1 per 1000 births in 1997 to 1.3 per 1000 births in 2007. This was associated with a statistically significant decline in risk factors: maternal smoking (from 20 to 12%), gestational age (from 57 to 47% ≥ 40 weeks of gestation), delivery at small hospitals (from 15 to 9%) and infants with birthweight below the third percentile (from 3.3 to 2.4%). There were simultaneous statistically significant increases in practices that reduce the risk of MAS: labour inductions (from 22 to 27%) and birth by caesarean section, both elective, prior to 40 weeks of gestation (from 7.3 to 13.8%), and emergency (from 3.0 to 5.3% prior to 40 weeks of gestation, and from 5.1 to 6.7% at 40 weeks of gestation or later). Conclusions  The rate of MAS is declining, and this decline is associated with a reduction in maternal and pregnancy risk factors, and an increase in protective obstetric practices.
Authors:
J Vivian-Taylor; J Sheng; Rm Hadfield; Jm Morris; Jr Bowen; Cl Roberts
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-9-6
Journal Detail:
Title:  BJOG : an international journal of obstetrics and gynaecology     Volume:  -     ISSN:  1471-0528     ISO Abbreviation:  -     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-9-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100935741     Medline TA:  BJOG     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.
Affiliation:
Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia Department of Obstetrics and Gynaecology Department of Neonatology, Royal North Shore Hospital, St Leonards, NSW, Australia.
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