Document Detail

The effect of placenta previa on neonatal mortality: a population-based study in the United States, 1989 through 1997.
MedLine Citation:
PMID:  12748502     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The purpose of the study was to explore the associations of placenta previa with preterm delivery, growth restriction, and neonatal survival. STUDY DESIGN: A retrospective cohort study was performed of live births in the United States (1989-1991 and 1995-1997) that used the national linked birth/infant death records from 22,368,235 singleton pregnancies. The diagnosis of previa was restricted to those live births that were delivered (> or =24 weeks) by cesarean delivery. We evaluated gestational age and birth weight-specific risk of neonatal deaths (within the first 28 days) in relation to placenta previa. Fetal growth was assessed in centiles of birth weight (<3rd, 3rd-4th, 5th-9th, 10th-90th, and >90th centile), adjusted for gestational age. All analyses were adjusted for the confounding effects of the year of delivery, maternal age, gravidity, education, prenatal care, marital status, and race/ethnicity. RESULTS: Placenta previa was recorded in 2.8 per 1000 live births (n = 61,711). Neonatal mortality rate was 10.7 with previa, compared with 2.5 per 1,000 among other pregnancies (relative risk, 4.3; 95% confidence interval, 4.0,4.8). At 28 to 36 weeks, babies born to women with placenta previa weighed, on average, 210 g lower than babies born to women without placenta previa (P <.001). Compared with babies born to women without previa, the risk of death from placenta previa was lower among preterm babies (<37 weeks of gestation), with a crossover at 37 weeks where the mortality rate was higher for babies born to women with placenta previa than for babies born to women without placenta previa. This crossover also persisted in an analysis by birth weight and term births (delivered at > or =37 weeks of gestation). Mortality rates for term births were higher among babies born to women with placenta previa than among babies born women without placenta previa who were at the 10th to 90th centile (relative risk, 1.9; 95% confidence interval, 1.3, 2.8), and those at >90th centile (relative risk, 3.6; 95% confidence interval, 1.3, 9.6). Among preterm births, however, placenta previa was not associated with increased neonatal mortality by fetal growth centiles. CONCLUSION: The risk of neonatal mortality was higher for babies born to women with placenta previa than for babies born to women without placenta previa who were delivered at > or =37 weeks of gestation. Pregnancies that are diagnosed with placenta previa must be monitored carefully, especially as they approach term.
Cande V Ananth; John C Smulian; Anthony M Vintzileos
Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  188     ISSN:  0002-9378     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2003 May 
Date Detail:
Created Date:  2003-05-15     Completed Date:  2003-06-19     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1299-304     Citation Subset:  AIM; IM    
Section of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School/Saint Peter's University Hospital, New Brunswick, NJ, USA.
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MeSH Terms
Cohort Studies
Gestational Age
Infant Mortality*
Infant, Newborn
Middle Aged
Placenta Previa / mortality*
Retrospective Studies
United States / epidemiology
Grant Support

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