ABSTRACT
We compared neonatal outcomes from singleton pregnancies in women hospitalized with preterm labor (PTL) at 32 0/7 to 34 6/7 weeks managed with and without acute tocolysis. Women enrolled for outpatient surveillance who were hospitalized and diagnosed with PTL between 32 0/7; to 34 6/7 weeks' gestation without conditions necessitating interventional delivery during hospitalization were identified (n = 2921). Patients with contraindications to pregnancy prolongation were excluded (n = 168). Data were compared between patients whose clinical management included tocolysis (n = 2342) and patients in whom tocolysis was not utilized (n = 411). The incidence of preterm birth (77.9% versus 48.1%), low birth weight (48.9% versus 16.7%), neonatal intensive care unit admission (41.4% versus 16.2%), and nursery length of stay > 7 days (28.0% versus 9.7%) were all higher in women not receiving acute tocolysis compared with the acute tocolysis group (all p < 0.001). Using acute tocolysis to prolong pregnancy in patients hospitalized with PTL at 32 0/7 to 34 6/7 weeks' gestation is associated with improved neonatal outcomes.
KEYWORDS
Neonatal outcome - prematurity prevention - preterm labor - tocolysis
REFERENCES
-
1 Martin J A, Hamilton B E, Sutton P D et al.. Births: Final data for 2004. National vital statistics reports, Vol. 55, No. 1. Hyattsville, MD; National Center for Health Statistics 2006
-
2
Raju T N, Higgins R D, Stark A R, Leveno K J.
Optimizing care and outcome for late-preterm (near-term) infants: a summary of the workshop sponsored by the National Institute of Child Health and Human Development.
Pediatrics.
2006;
118
1207-1214
-
3
How H Y, Zafaranchi L, Stella C L et al..
Tocolysis in women with preterm labor between 32 0/7 and 34 6/7 weeks of gestation: a randomized controlled pilot study.
Am J Obstet Gynecol.
2006;
194
976-981
-
4
Committee on Obstetric Practice .
ACOG Committee Opinion: antenatal corticosteroid therapy for fetal maturation.
Obstet Gynecol.
2002;
99
871-873
-
5
Wang M L, Dorer D J, Fleming M P, Catlin E A.
Clinical outcomes of near-term infants.
Pediatrics.
2004;
114
372-376
-
6
Gladstone I M, Katz V L.
The morbidity of the 34- to 35-week gestation: should we reexamine the paradigm?.
Am J Perinatol.
2004;
21
9-13
-
7
Phibbs C S, Schmitt S K.
Estimates of the cost and length of stay changes that can be attributed to one-week increases in gestational age for premature infants.
Early Hum Dev.
2006;
82
85-95
-
8
Elliott J P, Istwan N B, Jacques D L, Coleman S K, Stanziano G J.
Consequences of nonindicated preterm delivery in singleton gestations.
J Reprod Med.
2003;
48
713-717
-
9
Jones J S, Istwan N B, Jacques D, Coleman S K, Stanziano G.
Is 34 weeks an acceptable goal for a complicated singleton pregnancy?.
Manag Care.
2002;
11
42-47
-
10
Gilbert W M.
The cost of preterm birth: the low cost versus high value of tocolysis.
BJOG.
2006;
113
4-9
-
11
Berkman N D, Thorp J M, Lohr K N et al..
Tocolytic treatment for the management of preterm labor: a review of the evidence.
Am J Obstet Gynecol.
2003;
188
1648-1659
John P ElliottM.D.
Phoenix Perinatal Associates, Good Samaritan Medical Center
1111 East McDowell, Phoenix, Arizona 85006. Reprints will not be available.
Email: john_elliott@obstetrix.com