Kurkinen-Raty, M., Koivisto, M., & Jouppila, P. (2000). Preterm delivery for maternal or fetal indications: maternal morbidity, neonatal outcome and late sequelae in infants. BJOG : an international journal of obstetrics and gynaecology, 107(5), 648-655. https://doi.org/10.1111/j.1471-0528.2000.tb13308.x
Kurkinen-Raty M, Koivisto M, Jouppila P. Preterm delivery for maternal or fetal indications: maternal morbidity, neonatal outcome and late sequelae in infants. BJOG. 2000;107(5):648-655. doi:10.1111/j.1471-0528.2000.tb13308.x
Kurkinen-Raty, M., et al. "Preterm Delivery for Maternal or Fetal Indications: Maternal Morbidity, Neonatal Outcome and Late Sequelae in Infants." BJOG : an international journal of obstetrics and gynaecology, vol. 107, no. 5, 2000, pp. 648-655.
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Department of Obstetrics and Gynaecology, University of Oulu, Finland.
To assess maternal morbidity, and neonatal outcome and especially long term sequelae in infants born preterm due to maternal or fetal indications.
Design
Analysis of retrospective cohort.
Setting
Oulu University Central Hospital, Finland.
Population
One hundred and three women, who were between the 24th and the 33rd week of pregnancy, delivered by caesarean delivery because of maternal or fetal indications. They were matched with 103 women who had spontaneous preterm delivery at corresponding gestational weeks between 1990-1997.
Main Outcome Measures
Maternal morbidity, reasons for caesarean delivery, neonatal mortality and morbidity rates, and later development of the infants.
Results
Pre-eclampsia was diagnosed in 57% of the women in the indicated group and only in one woman in the control group. All infants in the indicated group and almost a third in the control group were born by caesarean birth; the main indication was threatening fetal asphyxia. There was a significant difference in neonatal mortality rates between the groups (175 vs 78 per thousand live births in the indicated vs control infants; RR 2.3, 95% CI 1.02, 4.9) and the main cause of death was respiratory insufficiency: 64% in the indicated group and 22% in the controls; RR 2.9, 95% CI 0.8, 10. Respiratory distress syndrome occurred more often (73% vs 53%, RR 1.4, 95% CI 1.1, 1.7) and it was more severe and more complicated in infants in the indicated group, compared with those in the control group. Symptomatic chronic lung disease at one year of age was more common in infants in the indicated group than in the control group (15% vs 3%; RR 4.6, 95% CI 1.4, 15.9).
Conclusions
Not only the risks of neonatal mortality and morbidity but also long term pulmonary consequences, appear to be greater in infants born preterm by indicated delivery than in preterm infants born spontaneously at corresponding weeks.
Preterm infants are at 8 times higher risk than term infants for pre- and perinatal brain damage, resulting in cerebral palsy. In this paper we have analysed the influence of prenatal and birth-related risk factors on cerebral palsy in preterm infants. In a register-based study, 175 preterm singleton infants with cerebral palsy, born in 1982-86, were compared with 687 controls matched by gestational age and year of birth. Statistically significant higher rates in cases were found in parity > or = 3 (22% vs. 16%, p < 0.05), Cesarean section (67% vs. 56%, p < 0.01), and low Apgar scores at 1 minute (45% vs. 36%, p < 0.05). By multivariate analyses, two variables remained statistically significant: parity > or = 3 (adjusted OR = 1.53 (95% CI 1.00-2.34), p < 0.05) and Cesarean section (adjusted OR = 1.57 (95% CI 1.07-2.32), p < 0.05). Pregnancy complications preceding preterm birth did not imply a higher risk of cerebral palsy. Delivery by Cesarean section was a prognostic factor for developing cerebral palsy, and the predictive value of Apgar scores was highly limited.
To test whether subfertile women may be at higher risk of preterm delivery. We used data from two population-based cohort studies on risk factors and pregnancy outcome for approximately 20,000 deliveries in three major Danish obstetric departments. The Aalborg-Odense study comprised all pregnant women attending routine antenatal care at two obstetric departments from 1984 to 1987. In all, 11,850 women (86%) filled in a questionnaire at about 36 weeks' gestation. The Aarhus study addressed women at the routine visit near 16 weeks' gestation from 1989 to 1991; a study questionnaire was returned by 6857 (80%). Both studies excluded women with chronic illnesses, multiple fetuses, and inability to speak Danish. Only women with planned pregnancies were included in the analysis. In all, 8855 and 3985 women from Aalborg-Odense and Aarhus, respectively, were eligible for the analyses. In both cohorts, women were categorized according to their waiting time to pregnancy (0-6 months, 7-12 months, and greater than 1 year) and according to examination or treatment for infertility (yes, no). Preterm delivery was defined as birth before 37 completed weeks. Compared with women who tried for 6 months or less before they conceived, women who tried for 7-12 months had 1.3 times (95% confidence interval [CI] 0.8, 2.1) the adjusted risk of preterm delivery in both cohorts, and women with a time to pregnancy of greater than 12 months had adjusted relative risks for preterm delivery of 1.6 (95% CI 1.1, 2.2) for Aalborg-Odense and 1.7 (95% CI 1.1, 2.6) for Aarhus. The results remained similar after excluding women with infertility treatment. Pregnant women with subfertility and clinically defined infertility are more prone to preterm delivery, even in the absence of infertility treatment.
Lee YL et al., 2022·Scientific Reports·Free full text on PubMed Central
Preterm delivery of low-birth weight infants is considered a leading cause of morbidity and mortality among neonates. Various studies have reported a positive correlation between periodontal disease (PD) and premature birth (PB) and yet no population-based study has assessed the impact of PD severity and treatments on premature birth. This cohort study used Taiwan's national medical records (1999-2012, included 1,757,774 pregnant women) to investigate the association between PD severity and PB. Women with PD during the 2-year period prior for giving birth were more likely to have PB (11.38%) than those without PD (10.56%; p < 0.001). After variables adjustment, the advanced PD group had OR of 1.09 (95% CI 1.07-1.11) for PB, the mild PD group had OR of 1.05 (95% CI 1.04-1.06), while no-PD group had OR of 1. Increased PD severity was related to higher risk of PB. When stratified by age, the highest ORs for PB were those aged from 31 to 35 years in both mild PD group (OR = 1.09, 95% CI 1.07-1.11) and advanced PD group (OR = 1.13, 95% CI 1.09-1.17). Improving periodontal health before or during pregnancy may prevent or reduce the occurrence of adverse pregnancy outcomes and therefore maternal and perinatal morbidity and mortality.
Everest NJ et al., 2008·Archives of disease in childhood. Fetal and neonatal edition
Rupture of the membranes in the second trimester is reported to be associated with high rates of pregnancy loss, neonatal mortality and morbidity. This article describes the outcomes of liveborn infants delivered following a prolonged period of membrane rupture occurring before 24 weeks' gestation. Over a 5-year period, consecutive pregnancies complicated by spontaneous rupture of the membranes before 24 weeks' gestation were identified. Evaluation of short-term outcomes before discharge of liveborn infants delivered, in a tertiary referral centre, following prolonged rupture of membranes of duration greater than 2 weeks. Of 98 pregnancies identified with rupture of the membranes before 24 weeks' gestation, 40 (41%) women progressed to deliver a liveborn infant following a latent period of at least 14 days. Although most liveborn infants required neonatal intensive care including mechanical ventilation (n = 38; 78%), the survival rate to hospital discharge was 70% (n = 28). Airleak occurred in 7 (25%) survivors and 8 (67%) deaths. Among the survivors, 12 (43%) required supplemental oxygen at 36 weeks' postmenstrual age and no infant had grade 3 or 4 intraventricular haemorrhage. One infant had a postmortem diagnosis of pulmonary hypoplasia and nine others had clinical features consistent with this diagnosis. Low liquor volume was not uniformly associated with a poor outcome. With full contemporary neonatal intensive care, the outcome for liveborn infants in the present cohort delivered following membrane rupture occurring before 24 weeks' gestation, of at least 14 days duration, was better than previously reported.
PMID 10826581 10826581 DOI 10.1111/j.1471-0528.2000.tb13308.x 10.1111/j.1471-0528.2000.tb13308.x Kurkinen-Raty et al. 2000, Kurkinen-Raty 2000
Cite this article
Kurkinen-Raty, M., Koivisto, M., & Jouppila, P. (2000). Preterm delivery for maternal or fetal indications: maternal morbidity, neonatal outcome and late sequelae in infants. BJOG : an international journal of obstetrics and gynaecology, 107(5), 648-655. https://doi.org/10.1111/j.1471-0528.2000.tb13308.x
Kurkinen-Raty M, Koivisto M, Jouppila P. Preterm delivery for maternal or fetal indications: maternal morbidity, neonatal outcome and late sequelae in infants. BJOG. 2000;107(5):648-655. doi:10.1111/j.1471-0528.2000.tb13308.x
Kurkinen-Raty, M., et al. "Preterm Delivery for Maternal or Fetal Indications: Maternal Morbidity, Neonatal Outcome and Late Sequelae in Infants." BJOG : an international journal of obstetrics and gynaecology, vol. 107, no. 5, 2000, pp. 648-655.
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