| When should women with placenta previa be delivered? A decision analysis. | |
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MedLine Citation:
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PMID: 21043362 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Marya G Zlatnik; Sarah E Little; Puja Kohli; Anjali J Kaimal; Naomi E Stotland; Aaron B Caughey |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Journal of reproductive medicine Volume: 55 ISSN: 0024-7758 ISO Abbreviation: J Reprod Med Publication Date: 2010 Sep-Oct |
Date Detail:
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Created Date: 2010-11-03 Completed Date: 2010-11-30 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0173343 Medline TA: J Reprod Med Country: United States |
Other Details:
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Languages: eng Pagination: 373-81 Citation Subset: IM |
Affiliation:
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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 |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adrenal Cortex Hormones
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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:
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0/Adrenal Cortex Hormones |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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