{"id":{"repo_id":"umkc","oai_identifier":"oai:mospace.umsystem.edu:10355/65997"},"canonical_url":"https://search.dev.ndltd.org/etd/umkc/oai:mospace.umsystem.edu:10355/65997","repository":{"repo_id":"umkc","name":"University of Missouri - Kansas City","base_url":"https://mospace.umsystem.edu/oai/request"},"display":{"title":"Risk of Expectant Management and Optimal Timing of Delivery in Low-risk Term Pregnancies: A Population-based Study","abstract":"Introduction The benefits of the current obstetric recommendation to avoid elective deliveries before 39 weeks of gestation in pregnant women have been questioned by several authors.1 5 Multiple concerns such as increased stillbirth rates, intensive care admission and post maturity syndrome occurring after avoiding elective deliveries before 39 weeks have been raised. Whether the risk of expectant management outweighs the benefits of reaching 39 weeks of gestation has not been studied. Purpose/Objective The objective of this study was to analyze the effect of expectant management in the optimal timing for delivery. Design/Methods Subjects included were all singleton pregnancies that delivered during the term in the year of 2013. Those with complications such as congenital anomalies, diabetes, hypertension, and fetal growth restriction were excluded. Composite outcomes and individual maternal complications, stillbirth rates, neonatal complications and infant death rates were compared among cases that underwent expectant management vs. deliveries that occurred at each term gestational age. Binary logistic regression was employed to calculate odds ratios for complications according to delivery plan at each gestational age at term. Common confounders in the obstetric literature were selected as covariates in the regression models. From 3,994,796 deliveries, 3,199,246 (80.1%) fulfilled inclusion criteria. Maternal complications during expectant management were significantly lower at the early-term period and became higher at 39 weeks and above, RR (95% CI) = 1.18 (1.16 – 1.19). Neonatal complication rates during expectant management were also significantly lower during the early-term period, and became higher at 39 weeks and above, RR (95% CI) = 1.09 (1.08 – 1.09). The risk of perinatal mortality in the expectant management group was significantly lower during the early-term period, and became higher at 39 weeks and above, RR (95% CI) = 18.93 (17.83 – 20.10) vs. 17.37 (16.61 – 18.16), p = 0.010. Based on these findings, it can be concluded that complications that arise during expectant management while awaiting full-term do not outweigh the benefits of achieving better outcomes from attempting to reach 39 weeks. However, extending beyond 39 weeks may put these pregnancies at increased risk.","abstract_html":"Introduction The benefits of the current obstetric recommendation to avoid elective deliveries before 39 weeks of gestation in pregnant women have been questioned by several authors.1 5 Multiple concerns such as increased stillbirth rates, intensive care admission and post maturity syndrome occurring after avoiding elective deliveries before 39 weeks have been raised. Whether the risk of expectant management outweighs the benefits of reaching 39 weeks of gestation has not been studied. Purpose/Objective The objective of this study was to analyze the effect of expectant management in the optimal timing for delivery. Design/Methods Subjects included were all singleton pregnancies that delivered during the term in the year of 2013. Those with complications such as congenital anomalies, diabetes, hypertension, and fetal growth restriction were excluded. Composite outcomes and individual maternal complications, stillbirth rates, neonatal complications and infant death rates were compared among cases that underwent expectant management vs. deliveries that occurred at each term gestational age. Binary logistic regression was employed to calculate odds ratios for complications according to delivery plan at each gestational age at term. Common confounders in the obstetric literature were selected as covariates in the regression models. From 3,994,796 deliveries, 3,199,246 (80.1%) fulfilled inclusion criteria. Maternal complications during expectant management were significantly lower at the early-term period and became higher at 39 weeks and above, RR (95% CI) = 1.18 (1.16 – 1.19). Neonatal complication rates during expectant management were also significantly lower during the early-term period, and became higher at 39 weeks and above, RR (95% CI) = 1.09 (1.08 – 1.09). The risk of perinatal mortality in the expectant management group was significantly lower during the early-term period, and became higher at 39 weeks and above, RR (95% CI) = 18.93 (17.83 – 20.10) vs. 17.37 (16.61 – 18.16), p = 0.010. Based on these findings, it can be concluded that complications that arise during expectant management while awaiting full-term do not outweigh the benefits of achieving better outcomes from attempting to reach 39 weeks. However, extending beyond 39 weeks may put these pregnancies at increased risk.","abstract_has_math":false,"creators":["Vilchez, Gustavo"],"institution":"University of Missouri -- Kansas City","degree_name":"M.S.","degree_level":"Masters","degree_discipline":"Bioinformatics (UMKC)","degree_department":null,"school":null,"contributors":[],"advisors":["Gaddis, Monica Louise, 1955-"],"committee_chairs":[],"committee_members":[],"year":2018,"date_issued":"2018","date_published":"2018","updated_at":"2026-07-24T05:16:44Z","subjects":[],"languages":["en_US"],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://hdl.handle.net/10355/65997","outbound_label":"Handle","outbound_source":"dc:identifier.uri"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.advisor","label":"Advisor","values":["Gaddis, Monica Louise, 1955-"]},{"key":"dc:creator","label":"Author","values":["Vilchez, Gustavo"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.accessioned","label":"Dc Date Accessioned","values":["2018-09-27T14:27:39Z"]},{"key":"dc:date.available","label":"Dc Date Available","values":["2018-09-27T14:27:39Z"]},{"key":"dc:date.issued","label":"Date","values":["2018"]},{"key":"dc:publisher","label":"Institution","values":["University of Missouri -- Kansas City"]},{"key":"dc:type","label":"Dc Type","values":["Thesis"]},{"key":"thesis:degree_discipline","label":"Discipline","values":["Bioinformatics (UMKC)"]},{"key":"thesis:degree_level","label":"Degree Level","values":["Masters"]},{"key":"thesis:degree_name","label":"Degree Name","values":["M.S."]},{"key":"thesis:institution_name","label":"Thesis Institution Name","values":["University of Missouri--Kansas City"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language.iso","label":"Language (ISO)","values":["en_US"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["https://hdl.handle.net/10355/65997"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["Title from PDF of title page viewed October 1, 2018","Thesis advisor: Monica Gaddis","Vita","Includes bibliographical references (pages 34-41)","Thesis (M.S.)--School of Medicine. University of Missouri--Kansas City, 2018"]},{"key":"dc:description.abstract","label":"Abstract","values":["Introduction The benefits of the current obstetric recommendation to avoid elective deliveries before 39 weeks of gestation in pregnant women have been questioned by several authors.1 5 Multiple concerns such as increased stillbirth rates, intensive care admission and post maturity syndrome occurring after avoiding elective deliveries before 39 weeks have been raised. Whether the risk of expectant management outweighs the benefits of reaching 39 weeks of gestation has not been studied. Purpose/Objective The objective of this study was to analyze the effect of expectant management in the optimal timing for delivery. Design/Methods Subjects included were all singleton pregnancies that delivered during the term in the year of 2013. Those with complications such as congenital anomalies, diabetes, hypertension, and fetal growth restriction were excluded. Composite outcomes and individual maternal complications, stillbirth rates, neonatal complications and infant death rates were compared among cases that underwent expectant management vs. deliveries that occurred at each term gestational age. Binary logistic regression was employed to calculate odds ratios for complications according to delivery plan at each gestational age at term. Common confounders in the obstetric literature were selected as covariates in the regression models. From 3,994,796 deliveries, 3,199,246 (80.1%) fulfilled inclusion criteria. Maternal complications during expectant management were significantly lower at the early-term period and became higher at 39 weeks and above, RR (95% CI) = 1.18 (1.16 – 1.19). Neonatal complication rates during expectant management were also significantly lower during the early-term period, and became higher at 39 weeks and above, RR (95% CI) = 1.09 (1.08 – 1.09). The risk of perinatal mortality in the expectant management group was significantly lower during the early-term period, and became higher at 39 weeks and above, RR (95% CI) = 18.93 (17.83 – 20.10) vs. 17.37 (16.61 – 18.16), p = 0.010. Based on these findings, it can be concluded that complications that arise during expectant management while awaiting full-term do not outweigh the benefits of achieving better outcomes from attempting to reach 39 weeks. However, extending beyond 39 weeks may put these pregnancies at increased risk."]},{"key":"dc:title","label":"Title","values":["Risk of Expectant Management and Optimal Timing of Delivery in Low-risk Term Pregnancies: A Population-based Study"]}]}],"canonical_facts":{"dc:contributor.advisor":["Gaddis, Monica Louise, 1955-"],"dc:creator":["Vilchez, Gustavo"],"dc:date.accessioned":["2018-09-27T14:27:39Z"],"dc:date.available":["2018-09-27T14:27:39Z"],"dc:date.issued":["2018"],"dc:description":["Title from PDF of title page viewed October 1, 2018","Thesis advisor: Monica Gaddis","Vita","Includes bibliographical references (pages 34-41)","Thesis (M.S.)--School of Medicine. University of Missouri--Kansas City, 2018"],"dc:description.abstract":["Introduction The benefits of the current obstetric recommendation to avoid elective deliveries before 39 weeks of gestation in pregnant women have been questioned by several authors.1 5 Multiple concerns such as increased stillbirth rates, intensive care admission and post maturity syndrome occurring after avoiding elective deliveries before 39 weeks have been raised. Whether the risk of expectant management outweighs the benefits of reaching 39 weeks of gestation has not been studied. Purpose/Objective The objective of this study was to analyze the effect of expectant management in the optimal timing for delivery. Design/Methods Subjects included were all singleton pregnancies that delivered during the term in the year of 2013. Those with complications such as congenital anomalies, diabetes, hypertension, and fetal growth restriction were excluded. Composite outcomes and individual maternal complications, stillbirth rates, neonatal complications and infant death rates were compared among cases that underwent expectant management vs. deliveries that occurred at each term gestational age. Binary logistic regression was employed to calculate odds ratios for complications according to delivery plan at each gestational age at term. Common confounders in the obstetric literature were selected as covariates in the regression models. From 3,994,796 deliveries, 3,199,246 (80.1%) fulfilled inclusion criteria. Maternal complications during expectant management were significantly lower at the early-term period and became higher at 39 weeks and above, RR (95% CI) = 1.18 (1.16 – 1.19). Neonatal complication rates during expectant management were also significantly lower during the early-term period, and became higher at 39 weeks and above, RR (95% CI) = 1.09 (1.08 – 1.09). The risk of perinatal mortality in the expectant management group was significantly lower during the early-term period, and became higher at 39 weeks and above, RR (95% CI) = 18.93 (17.83 – 20.10) vs. 17.37 (16.61 – 18.16), p = 0.010. Based on these findings, it can be concluded that complications that arise during expectant management while awaiting full-term do not outweigh the benefits of achieving better outcomes from attempting to reach 39 weeks. However, extending beyond 39 weeks may put these pregnancies at increased risk."],"dc:identifier.uri":["https://hdl.handle.net/10355/65997"],"dc:language.iso":["en_US"],"dc:publisher":["University of Missouri -- Kansas City"],"dc:title":["Risk of Expectant Management and Optimal Timing of Delivery in Low-risk Term Pregnancies: A Population-based Study"],"dc:type":["Thesis"],"thesis:degree_discipline":["Bioinformatics (UMKC)"],"thesis:degree_level":["Masters"],"thesis:degree_name":["M.S."],"thesis:institution_name":["University of Missouri--Kansas City"]},"updated_at":"2026-07-24T05:16:44Z"}