Document Detail


When should women with placenta previa be delivered? A decision analysis.
MedLine Citation:
PMID:  21043362     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine the optimal gestational age of delivery for women with placenta previa by accounting for both neonatal and maternal outcomes.
STUDY DESIGN: A decision-analytic model was designed comparing total maternal and neonatal quality-adjusted life years for delivery of women with previa at gestational ages from 34 to 38 weeks. At each week, we allowed for four different delivery strategies: (1) immediate delivery, without amniocentesis or steroids; (2) delivery 48 hours after steroid administration (without amniocentesis); (3) amniocentesis with delivery if fetal lung maturity (FLM) positive or retesting in one week if FLM negative; (4) amniocentesis with delivery if FLM testing is positive or administration of steroids if FLM negative.
RESULTS: Delivery at 36 weeks, 48 hours after steroids, for women with previa optimizes maternal and neonatal outcomes. In sensitivity analyses, these results were robust to a wide range of variation in input assumptions. If it is assumed that steroids offer no neonatal benefit at this gestational age, outright delivery at 36 weeks' gestation is the best strategy.
CONCLUSION: Steroid administration at 35 weeks and 5 days followed by delivery at 36 weeks for women with placenta previa optimizes maternal and neonatal outcomes.
Authors:
Marya G Zlatnik; Sarah E Little; Puja Kohli; Anjali J Kaimal; Naomi E Stotland; Aaron B Caughey
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of reproductive medicine     Volume:  55     ISSN:  0024-7758     ISO Abbreviation:  J Reprod Med     Publication Date:    2010 Sep-Oct
Date Detail:
Created Date:  2010-11-03     Completed Date:  2010-11-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0173343     Medline TA:  J Reprod Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  373-81     Citation Subset:  IM    
Affiliation:
Center for Clinical and Policy Perinatal Research, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California-San Francisco, San Francisco, California 94143, USA. zlatnikm@obgyn.ucsf.edu
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex Hormones / therapeutic use
Amniocentesis
Cesarean Section*
Decision Support Techniques*
Delivery, Obstetric*
Female
Fetal Organ Maturity
Gestational Age*
Humans
Hysterectomy
Infant, Newborn
Placenta Previa* / drug therapy,  surgery
Pregnancy
Premature Birth*
Quality-Adjusted Life Years
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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