Outcomes of Medically Indicated Preterm Births Differ by Indication

Michelle J. Wang; Spencer G. Kuper; Robin Steele; Rachel A. Sievert; Alan T. Tita; Lorie M. Harper

doi:10.1055/s-0037-1615792

American Journal of Perinatology, Table of Contents

Am J Perinatol 2018; 35(08): 758-763
DOI: 10.1055/s-0037-1615792

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Outcomes of Medically Indicated Preterm Births Differ by Indication

Michelle J. Wang

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama

,

Spencer G. Kuper

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama

,

Robin Steele

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama

,

Rachel A. Sievert

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama

,

Alan T. Tita

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama

,

Lorie M. Harper

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama

› Author Affiliations

Abstract

Objective We aim to examine whether outcomes of preterm birth (PTB) are further modified by the indication for delivery.

Study Design We performed a retrospective cohort study of all singletons delivered at 23 to 34 weeks from 2011 to 2014. Women were classified by their primary indication for delivery: maternal (preeclampsia) or fetal/obstetric (growth restriction, nonreassuring fetal status, and vaginal bleeding). The primary neonatal outcome was a composite of neonatal death, cord pH <7 or base excess < − 12, 5-minute Apgar ≤3, C-reactive protein during resuscitation, culture-proven sepsis, intraventricular hemorrhage, and necrotizing enterocolitis. Secondary outcomes included the individual components of the primary outcome. Groups were compared using Student's t-test and chi-squared tests. Logistic regression was used to adjust for confounding variables.

Results Of 528 women, 395 (74.8%) were delivered for maternal and 133 (25.2%) for fetal/obstetric indications. Compared with those delivered for a maternal indication, those with a fetal/obstetric indication for delivery had an increased risk of the composite neonatal outcome (adjusted odds ratio [AOR]: 1.9, 95% confidence interval [CI]: 1.13–3.21) and acidemia at birth (AOR: 4.2, 95% CI: 1.89–9.55).

Conclusion Preterm infants delivered for fetal/obstetric indications have worsened outcomes compared with those delivered for maternal indications. Additional research is needed to further tailor counseling specific to the indication for delivery.

Keywords

preterm birth - neonatal morbidity - indication for preterm delivery - neonatal outcomes

Full Text

References

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