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Optimum time of delivery - Journal of Perinatology ArticleFrom: lclemos@aol.comFri Oct 13 08:38:32 2006
I believe this may have been the article referred to earlier regarding elective inductions - Note the low risk clients (page 396 if you get the article) appear to converge and cross for risk factors around 39 weeks (balancing negative maternal outcomes such as perineal trauma with negative fetal outcomes such as NICU admission or low APGAR). Laurie in ME (with thanks to Susan Leavitt Gullo of the IHI for knowing what article was referred to) ORIGINAL ARTICLE The impact of the interaction between increasing gestational age and obstetrical risk on birth outcomes: evidence of a varying optimal time of delivery JM Nicholson1,2, LC Kellar1,2 and GM Kellar3 1Department of Family Medicine and Community Health, University of Pennsylvania Health System, Philadelphia, PA, USA; 2Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Medical Center, Philadelphia, PA, USA and 3Business School, Penn State University – Delaware County, Media, PA, USA Objective: To estimate the gestational age ranges that result in optimal birth outcomes for each of four risk-defined groups. Study Design: Retrospective cohort study of singleton late thirdtrimester deliveries at a large urban teaching hospital between July 1995 and September 2003. Low-risk, advanced maternal age, hypertensive and diabetic patients were identified and grouped. Rates, by day of gestation at delivery, of cesarean delivery, major maternal perineal trauma, low 5-min APGAR score and NICU admission were determined for each study group. Results: Each study group had meaningful changes in rates of obstetric outcomes as a function of gestational age at delivery and these patterns differed from group to group. A unique optimal time of delivery (OTD) was estimated for each group. The low-risk group OTD was calculated to be 37 weeks 1 day to 41 weeks 0 day; the advanced maternal age group OTD was 38 weeks 5 days to 39 weeks 6 days; the hypertension group OTD was 39 weeks 2 days to 40 weeks 1 day; and the diabetes mellitus group OTD was 40 weeks 3 days to 41 weeks 1 day. Conclusions: The OTD varied based on obstetrical risk. Strategies to increase the proportion of deliveries that occur within the OTD for specific risk-defined groups could theoretically improve birth outcomes. Journal of Perinatology (2006) 26, 392–402. doi:10.1038/sj.jp.7211528 Keywords: gestational age; birth outcomes; cesarean delivery; NICU admission; obstetrical risk; optimal time of delivery Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="utf-8"
I believe this may have been the article referred to earlier regarding elective inductions -
Note the low risk clients (page 396 if you get the article) appear to converge and cross for risk factors around 39 weeks (balancing negative maternal outcomes such as perineal trauma with negative fetal outcomes such as NICU admission or low APGAR). Laurie in ME
(with thanks to Susan Leavitt Gullo of the IHI for knowing what article was referred to)
ORIGINAL ARTICLE
The impact of the interaction between increasing gestational age
and obstetrical risk on birth outcomes: evidence of a varying
optimal time of delivery
JM Nicholson1,2, LC Kellar1,2 and GM Kellar3
1Department of Family Medicine and Community Health, University of Pennsylvania Health System, Philadelphia, PA, USA; 2Center
for Clinical Epidemiology and Biostatistics, University of Pennsylvania Medical Center, Philadelphia, PA, USA and 3Business School,
Penn State University – Delaware County, Media, PA, USA
Objective: To estimate the gestational age ranges that result in optimal
birth outcomes for each of four risk-defined groups.
Study Design: Retrospective cohort study of singleton late thirdtrimester
deliveries at a large urban teaching hospital between July 1995
and September 2003. Low-risk, advanced maternal age, hypertensive and
diabetic patients were identified and grouped. Rates, by day of gestation at
delivery, of cesarean delivery, major maternal perineal trauma, low 5-min
APGAR score and NICU admission were determined for each study group.
Results: Each study group had meaningful changes in rates of obstetric
outcomes as a function of gestational age at delivery and these patterns
differed from group to group. A unique optimal time of delivery (OTD)
was estimated for each group. The low-risk group OTD was calculated to
be 37 weeks 1 day to 41 weeks 0 day; the advanced maternal age group
OTD was 38 weeks 5 days to 39 weeks 6 days; the hypertension group OTD
was 39 weeks 2 days to 40 weeks 1 day; and the diabetes mellitus group
OTD was 40 weeks 3 days to 41 weeks 1 day.
Conclusions: The OTD varied based on obstetrical risk. Strategies to
increase the proportion of deliveries that occur within the OTD for specific
risk-defined groups could theoretically improve birth outcomes.
Journal of Perinatology (2006) 26, 392–402. doi:10.1038/sj.jp.7211528
Keywords: gestational age; birth outcomes; cesarean delivery; NICU
admission; obstetrical risk; optimal time of delivery
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