Factors Associated With Maternal and Neonatal Interventions at the Threshold of Viability
Factors Associated With Maternal and Neonatal Interventions at the Threshold of Viability
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DOI：
10.1097/aog.0000000000003875
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发表时间：
2020-06-01
影响因子：
7.2
通讯作者：
DeFranco, Emily A.
中科院分区：
文献类型：
--
作者：
Hajdu, Sierra A.;Rossi, Robert M.;DeFranco, Emily A.
目的：量化产妇社会人口学、医学和妊娠特征对提供或接受妊娠22-23周分娩的产前和新生儿干预决定的影响。方法：这是一项病例对照研究，使用2012年至2016年美国国家卫生统计中心生命统计出生记录，对妊娠22 0/7-23 6/7周的美国活产婴儿进行研究。我们分析了围生期分娩治疗的三个结局：1)孕产妇干预（剖宫产、孕产妇住院或产前皮质类固醇给药），2)新生儿干预（新生儿重症监护病房入院、表面活性剂给药、抗生素给药或辅助通气），以及3)联合干预（至少一项孕产妇和至少一项新生儿干预）。Logistic回归估计了特征对所接受的干预措施的影响。结果：在2012年至2016年的19,844,580例美国活产婴儿中，24,379例（0.12%）发生在妊娠22-23周。其中，37.5%接受了产妇干预，51.7%接受了新生儿干预，28.0%接受了综合干预。在妊娠22周和23周时，接受至少一项干预的出生率分别为38.9%和78.3%。子痫前期是与干预措施最相关的因素。其他与干预呈正相关的因素有产妇年龄增加、医疗补助、教育程度低、多胎、双胎妊娠和不孕症治疗。与新生儿干预相比，一些因素对产妇的影响相反。出生缺陷的存在与孕产妇干预呈正相关，但与新生儿干预呈负相关，而黑人种族与孕产妇干预呈负相关，但与新生儿干预呈正相关。结论：在生存能力阈值时，孕产妇和新生儿干预频繁发生，尤其是在妊娠23周时，干预的发生率超过50%。本研究确定了与使用围产干预措施相关的社会人口统计学和医学因素。这些数据阐明了观察到的围产管理实践模式，并可能有助于提供者对有围产风险的妇女进行咨询。
OBJECTIVE: To quantify the influence of maternal sociodemographic, medical, and pregnancy characteristics on decisions to offer or receive antepartum and neonatal interventions with deliveries occurring at 22-23 weeks of gestation. METHODS: This is a case-control study of U.S. live births at 22 0/7-23 6/7 weeks of gestation using National Center for Health Statistics vital statistics birth records from 2012 to 2016. We analyzed three outcomes in the treatment of periviable delivery: 1) maternal interventions (cesarean delivery, maternal hospital transfer or antenatal corticosteroid administration), 2) neonatal interventions (neonatal intensive care unit admission, surfactant administration, antibiotic administration, or assisted ventilation), and 3) combined interventions (at least one maternal and at least one neonatal intervention). Logistic regression estimated the influence of characteristics on interventions received. RESULTS: Of 19,844,580 U.S. live births from 2012 to 2016, 24,379 (0.12%) occurred at 22-23 weeks of gestation. Of these, 37.5% received maternal interventions, 51.7% received neonatal interventions, and 28.0% received combined interventions. Rates of births receiving at least one intervention were 38.9% and 78.3% for 22 and 23 weeks of gestation, respectively. Preeclampsia was the factor most positively associated with interventions. Other factors positively associated with interventions were increasing maternal age, Medicaid, low educational attainment, multiparity, twin gestation, and infertility treatment. Some factors had opposite influences on maternal compared with neonatal interventions. The presence of birth defects was positively associated with maternal interventions but negatively associated with neonatal interventions, whereas being of black race was negatively associated with maternal interventions but positively associated with neonatal interventions. CONCLUSION: Maternal and neonatal interventions occur frequently at the threshold of viability, especially at 23 weeks of gestation where the occurrence of interventions exceeds 50%. This study identifies sociodemographic and medical factors associated with using interventions with periviable deliveries. These data elucidate observed practice patterns in the management of periviable births and may assist providers in the counseling of women at risk of periviable birth.