Document Detail


The morbidity of the 34- to 35-week gestation: should we reexamine the paradigm?
MedLine Citation:
PMID:  15017476     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Algorithms for the management of preterm labor avoid the use of tocolysis beyond 34 weeks' gestation, based in large part on low respiratory morbidity found at this gestational age. We sought to delineate the morbidities, not just respiratory, of this age group in a modern neonatal intensive care unit setting. We prospectively looked at hospital resource use and general morbidity in a consecutive 2-year cohort of 34-weekers at our hospital. The concurrent consecutive 35-week cohort was used as a control. Data were prospectively collected from obstetricians and bedside records. Compared with 35-weekers, the 34-week group had similar obstetric characteristics. Significant differences were seen in use of oxygen, nasal continuous positive airway pressure, methylxanthines, home apnea monitoring, antibiotics, and phototherapy. The 34-week group took longer to come off intravenous lines and were discharged later. Overall, they used approximately twice the resources of the 35-week group. To stop or not use tocolysis at 34 weeks' gestation based mainly on low respiratory morbidity ignores the significant other morbidities. These findings suggest a reconsideration of the paradigm regarding 34-week gestation as a cutoff point in decision making.
Authors:
Igor M Gladstone; Vern L Katz
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of perinatology     Volume:  21     ISSN:  0735-1631     ISO Abbreviation:  Am J Perinatol     Publication Date:  2004 Jan 
Date Detail:
Created Date:  2004-03-12     Completed Date:  2004-06-03     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8405212     Medline TA:  Am J Perinatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  9-13     Citation Subset:  IM    
Affiliation:
Departments of Pediatrics and Obstetrics/Gynecology, Sacred Heart Medical Center, 1200 Hilyard Street #190, Eugene, OR 97401, USA.
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MeSH Terms
Descriptor/Qualifier:
Algorithms
Cohort Studies
Decision Making
Female
Gestational Age*
Humans
Infant, Newborn
Infant, Newborn, Diseases / epidemiology*,  etiology
Infant, Premature*
Intensive Care Units, Neonatal / statistics & numerical data
Male
New York City / epidemiology
Obstetric Labor, Premature / prevention & control
Practice Guidelines as Topic*
Pregnancy
Pregnancy Outcome
Pregnancy Trimester, Third
Prenatal Care / standards*
Prospective Studies
Tocolysis / standards*

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


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