Is indicated or spontaneous preterm delivery more advantageous for the fetus?

doi:10.1016/0002-9378(90)91085-Q

American Journal of Obstetrics and Gynecology

Volume 163, Issue 3, September 1990, Pages 868-872

https://doi.org/10.1016/0002-9378(90)91085-Q Get rights and content

Abstract

We performed a case-control study to determine whether fetuses delivered prematurely because of pregnancy complications (primarily pregnancy-associated hypertensive disease) had a different neonatal course than that of those born after either spontaneous preterm labor or after premature rupture of the membranes. Two case-control populations were matched by gestational age at delivery, fetal sex, and race. There was no perinatal survival advantage in babies delivered from “stressed” pregnancies. Selected neonatal morbidities were generally similar, but there was an increased incidence of necrotizing enterocolitis in babies born after preterm labor and a higher incidence of both necrotizing enterocolitis and neonatal sepsis after premature rupture of the membranes. We conclude that a “stressed” pregnancy confers a negligible survival advantage to the fetus

References (20)

AE Bent et al.
Assessment of fetal lung maturity: relationship of gestational age and pregnancy complications to phosphatidylglycerol levels
Am J Obstet Gynecol
(1982)
MV Kulovich et al.
The lung profile. II. Complicated pregnancy
Am J Obstet Gynecol
(1979)
TJ Yambao et al.
Amniotic fluid phosphatidylglycerol in stressed pregnancies
Am J Obstet Gynecol
(1981)
TJ Laatikainen et al.
Corticotropin-releasing hormone in amniotic fluid during gestation and labor and in relation to fetal lung maturation
Am J Obstet Gynecol
(1988)
TA Doran et al.
Amniotic fluid tests for fetal maturity in normal and abnormal pregnancies
Am J Obstet Gynecol
(1976)
WE Brenner et al.
A standard of fetal growth for the United States of America
Am J Obstet Gynecol
(1976)
A Ohlsson
Treatments of preterm premature rupture of the membranes: a meta-analysis
Am J Obstet Gynecol
(1989)
MJ Whittle
Lung maturation
Clin Obstet Gynaecol
(1984)
RH Usher et al.
Risk of respiratory distress syndrome related to gestational age, route of delivery, and maternal diabetes
Am J Obstet Gynecol
(1971)
RH Perelman et al.
Developmental aspects of lung lipids
Ann Rev Physiol
(1985)

There are more references available in the full text version of this article.

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Preterm Labor
2008, Family Medicine Obstetrics
Factors affecting survival in infants weighing 750 g or less
2005, European Journal of Obstetrics and Gynecology and Reproductive Biology
To assess which factors independently affect survival in infants weighing 750 g or less.
We reviewed the obstetric, neonatal, and placental pathology information of all non-malformed neonates with birth weight of 750 g or less from January 1998 to December 2002. Logistic regression analysis was used to control for the effect of confounding variables. A P < 0.05 was considered significant.
Fifty nine neonates fulfilled the inclusion criteria; 30 (51%) survived the perinatal period. Surviving neonates were more frequently born after steroid administration (P = 0.03) and from indicated delivery (P = 0.01), had greater birth weight (P = 0.001), gestational age at delivery (P < 0.001), and 5-min Apgar scores of 7 or more (P = 0.04) than those who died. There were no significant differences in placental pathology between survivors and neonates who died. Stepwise logistic regression analysis showed that gestational age (P = 0.01), birth weight (P = 0.004), female sex (P = 0.03), 5-min Apgar score (0.026), and steroid administration (P = 0.04) were independent predictors of survival. Cumulatively these five predictors explained 69% of neonatal survival.
The predictors of survival among micropremies are the same as those reported for older preterm neonates. The type of preterm delivery (spontaneous versus indicated) and placental pathology do not independently affect survival.
Indicated versus spontaneous preterm delivery: An evaluation of neonatal morbidity among infants weighing ≤1000 grams at birth
1999, American Journal of Obstetrics and Gynecology
Objective: The aim of the study was to determine whether infants weighing ≤1000 g after birth who are born to women who undergo indicated preterm delivery have different neonatal outcomes than do those born as a result of either spontaneous preterm labor or preterm premature rupture of membranes. Study Design: In a 1-year observational study (1992-1993) the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network collected outcome data for 799 infants whose birth weights were ≤1000 g. Only singleton infants with gestational age >20 weeks who were not produced as the result of an induced abortion were included. Our analysis was further limited to infants without major congenital anomalies who survived >2 days, were deemed potentially viable by the obstetrician, and would have undergone a cesarean delivery for fetal indications (N = 411). The primary reason for delivery was categorized as indicated delivery, spontaneous preterm labor, or spontaneous preterm premature rupture of membranes. Selected neonatal outcomes were evaluated among infants born to women in each of these groups. Logistic regression analyses were used to control for the effects of other potentially confounding variables. Results: A total of 156 of the 411 infants were born to women who underwent an indicated preterm delivery, whereas 160 were born after spontaneous preterm labor and 95 were delivered after preterm premature rupture of membranes. Univariate analyses revealed significantly lower incidences of grade III or IV intraventricular hemorrhage, grade III or IV retinopathy of prematurity, and seizure activity among infants born in an indicated preterm delivery than among those born after spontaneous preterm labor or preterm premature rupture of membranes. However, infants of women who underwent indicated preterm delivery had a more advanced mean gestational age at birth than did those born after spontaneous preterm labor or preterm premature rupture of membranes (28 ± 2 weeks, 26 ± 2 weeks, and 26 ± 1 weeks, respectively, P < .001). Multiple logistic regression analysis was therefore used to control for the disparity in gestational age. Multivariate analyses did not confirm the apparent improvement in neonatal outcome in the indicated delivery group. Conclusion: In this population of infants weighing ≤1000 g, selected neonatal outcomes did not differ according to birth by indicated preterm delivery, spontaneous preterm labor, or preterm premature rupture of membranes. (Am J Obstet Gynecol 1999;180:683-9.)
Implications of idiopathic preterm delivery for previous and subsequent pregnancies
1995, Obstetrics and Gynecology
To describe the relationship between pregnancy complications and fetal outcome in first and second pregnancies, focusing on idiopathic and indicated preterm birth of singleton infants in either pregnancy.
Included in the study were 13,967 women in Denmark who gave birth to their first singleton infant in 1982 and a second infant in 1982–1987. Information on pregnancy and birth was obtained by linking the National Medical Birth Register and the National Register of Hospital Discharges, based on personal identification numbers.
The risk of a preterm second birth in women with idiopathic and indicated preterm first birth did not differ significantly (15.2 and 12.8%, respectively). However, women with idiopathic preterm birth in the first pregnancy tended to repeat idiopathic preterm birth twice as often as women with indicated preterm birth repeated indicated preterm birth (11.3 versus 6.4%). Adjustment by logistic regression analysis for other risk factors for preterm birth did not influence the relative risk (6.0 before 32 weeks and 4.8 for 32–36 weeks) of a second preterm birth after a first preterm birth. Women with idiopathic preterm delivery in their first and second pregnancies gave birth to infants with lower birth weight than in previous or subsequent pregnancies. Emergency cesarean delivery in a first term pregnancy was a risk factor for subsequent idiopathic preterm birth.
Idiopathic preterm birth is associated with emergency cesarean delivery at term in previous pregnancies and infants with lower birth weight in previous and subsequent pregnancies.
Idiopathic preterm deliveries in Denmark
1995, Obstetrics and Gynecology
To characterize and quantify various demographic factors in idiopathic preterm delivery.
All women with a permanent address in Denmark and a singleton pregnancy who gave birth to a preterm infant in 1982 (N = 51,851) were included. The material was obtained by a linkage of the Medical Birth Register and the National Register of Hospital Discharges, using personal identification numbers.
The incidence of singleton preterm delivery was 4.5% (N = 2330), of which 67% (N = 1557) were idiopathic. The neonatal mortality rate was significantly lower with idiopathic than with indicated preterm birth. Following stepwise logistic regression analysis, age under 20 (adjusted odds ratio [OR] 1.63, 95% confidence interval [CI] 1.07–2.47; P < .03), age above 30 (adjusted OR 0.74, 95% CI 0.60–0.90; P < .004) and being married (adjusted OR 0.63, 95% CI 0.43-0.94; P < .03) correlated with idiopathic preterm birth.
Idiopathic preterm birth is more common in single, young women and is associated with a lower neonatal mortality rate than indicated preterm birth.
Neonatal outcome in preterm deliveries before 34-week gestation–the influence of the mechanism of labor onset
2019, Journal of Maternal-Fetal and Neonatal Medicine

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: Presented at the Tenth Annual Meeting of the Society of Perinatal Obstetricians, Houston, Texas, January 23–27, 1990.

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Is indicated or spontaneous preterm delivery more advantageous for the fetus?

Abstract

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Clin Obstet Gynaecol

Am J Obstet Gynecol

Developmental aspects of lung lipids

Ann Rev Physiol