Risk of Expectant Management and Optimal Timing of Delivery in Low-risk Term Pregnancies: A Population-based Study

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.

Name thesis:degree_name

M.S.

Level thesis:degree_level

Masters

Discipline thesis:degree_discipline

Bioinformatics (UMKC)

Grantor dc:publisher

University of Missouri -- Kansas City

Year dc:date.issued

2018

Author dc:creator

• Vilchez, Gustavo

Advisor dc:contributor.advisor

• Gaddis, Monica Louise, 1955-

Language dc:language.iso

en_US

Handle dc:identifier.uri

https://hdl.handle.net/10355/65997

OAI identifier oai:identifier

oai:mospace.umsystem.edu:10355/65997