Delivery indications at late-preterm gestations and infant mortality rates in the United States.
Delivery indications at late-preterm gestations and infant mortality rates in the United States.
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DOI：
10.1542/peds.2008-3232
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发表时间：
2009-07
期刊：
影响因子：
8
通讯作者：
Willinger M
中科院分区：
文献类型：
--
作者：
Reddy UM;Ko CW;Raju TN;Willinger M
在美国，早产率一直在上升，特别是妊娠34至36周的早产（晚期早产），现在占所有早产的71%。造成这些趋势的原因尚不清楚。我们描述了晚期早产的分娩指征及其对新生儿和婴儿死亡率的潜在影响。使用2001年美国出生队列相关的3483496例单胎出生/死亡文件，我们将分娩指征分类如下：（1）产妇医疗条件;（2）产科并发症;（3）重大先天性异常;（4）单独自然分娩：未经引产且无相关医疗/产科因素的阴道分娩;（5）无记录指征。在292627例晚期早产中，前4类（有指征和单独自然分娩）占76.8%。其余23.2%（67，909）被归类为无记录迹象的分娩。显著增加未记录适应症的可能性的因素是高龄产妇;非西班牙裔、白色母亲; ≥13年的教育;南部、中西部和西部地区;多产;或既往婴儿出生体重≥4000 g。新生儿和婴儿死亡率显着较高的分娩无记录的迹象相比，分娩继发于孤立的自然分娩，但较低的分娩与产科指征或先天性异常。共有23%的晚期早产没有出生证明上注明的分娩迹象。患者因素可能在这些分娩中发挥作用。值得关注的是，这些婴儿的死亡率高于那些自然分娩后出生的类似胎龄。鉴于死亡风险过高，患者和提供者需要讨论在34至36周无医学指征的情况下分娩早产儿的风险。
The rate of preterm births has been increasing in the United States, especially for births 34 to 36 weeks of gestation (late preterm), which now constitute 71% of all preterm births. The causes for these trends remain unclear. We characterized the delivery indications for late preterm births and their potential impact on neonatal and infant mortality rates. Using the 2001 US Birth Cohort Linked birth/death files of 3 483 496 singleton births, we categorized delivery indications as follows: (1) maternal medical conditions; (2) obstetric complications; (3) major congenital anomalies; (4) isolated spontaneous labor: vaginal delivery without induction and without associated medical/obstetric factors; and (5) no recorded indication. Of the 292 627 late-preterm births, the first 4 categories (those with indications and isolated spontaneous labor) accounted for 76.8%. The remaining 23.2% (67 909) were classified as deliveries with no recorded indication. Factors significantly increasing the chance of no recorded indication were older maternal age; non-Hispanic, white mother; ≥13 years of education; Southern, Midwestern, and Western region; multiparity; or previous infant with a ≥4000-g birth weight. The neonatal and infant mortality rates were significantly higher among deliveries with no recorded indication compared with deliveries secondary to isolated spontaneous labor but lower compared with deliveries with an obstetric indication or congenital anomaly. A total of 23% of late preterm births had no recorded indication for delivery noted on birth certificates. Patient factors may be playing a role in these deliveries. It is concerning that these infants had higher mortality rates compared with those born after spontaneous labor at similar gestational ages. Given the excess risk of mortality, patients and providers need to discuss the risks of delivering a pre-term infant in the absence of medical indications at 34 to 36 weeks.
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影响因子：
5
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PIPER, JM;MITCHEL, EF;TAYLOR, P
通讯作者：
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