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At least 19 recordsLinked to original sources
PubMed1997

Post-term birth: risk factors and outcomes in a 10-year cohort of Norwegian births.

OBJECTIVE: To identify factors associated with post-term birth and factors associated with adverse outcomes in post-term births. METHODS: The sample was a 10-year cohort (1978-1987) of term (n = 379,445) and post-term (n = 65,796) births from the Medical Birth Registry of Norway. Gestational age was based on mothers' recall of the last menstrual period. Multivariate analyses included proportional hazards regression and binomial logistic regression. RESULTS: After controlling for covariates, there was only a slightly increased risk of perinatal mortality in post-term as compared with term births (adjusted relative risk [RR] 1.11; 95% confidence interval [CI] 0.97, 1.27). For post-term births, risk factors for perinatal mortality were small size for gestational age (SGA) (adjusted RR 5.68; 95% CI 4.37, 7.38) and maternal age 35 years or older (adjusted RR 1.88; 95% CI 1.22, 2.89), whereas large size for gestational age (LGA) was a protective factor (adjusted RR 0.51; 95% CI 0.26, 1.00). Similar risk factor RRs were found for perinatal mortality in term births. Fetal distress was associated with both SGA and post-term birth; labor dysfunction and obstetric trauma were associated with both LGA and post-term birth; shoulder dystocia and maternal hemorrhage were associated with LGA only. CONCLUSIONS: Among post-term births, maternal complications were generally associated with larger fetal size, and fetal complications were associated with smaller fetal size. The evidence for an adverse impact on perinatal mortality of post-term birth is weak once other factors are taken into account.

Adult↗
PubMed1996

Perinatal mortality in term and post-term births.

Our aim was to compare the fetal mortality rate (FMR), early neonatal mortality rate (ENMR) and perinatal mortality rate (PMR) of post-term and term births, 2) to examine trends in the incidence and perinatal mortality rates of post-term and term births. We used data from Spanish Perinatal Mortality Survey of 1980, 1986, 1989 and 1992. The data include 40,863 post-term births (42 weeks and over) and 517,060 term births (37-41 weeks). Perinatal mortality rates of post-term and term births were compared. The incidence of post-term births was 7.3%. The relative risk (RR) of FMR for post-term compared to term births was 1.1 (95% confidence interval [CI] 0.9-1.3), of ENMR was 1.6 (95% CI 1.4-2.0) and of PMR was 1.3 (95% CI 1.1-1.5). From 1980 to 1992 there was a significant reduction in the incidence of post-term births (8.1% vs 5.0%), in the FMR (4.5/1000 vs 1.9/1000), ENMR (4.3/1000 vs 2.0/1000) and PMR (8.7/1000 vs 3.9/1000) of post-term births. There was no significant difference in the FMR between post-term and term in each year studied. Post-term births had a significantly higher ENMR and PMR than term births in 1980, and they were equivalent from 1983 to 1992. The incidence of post-term births, its FMR, ENMR and PMR have been significantly reduced during the whole period studied.

Female↗
PubMed1976

Factors associated with spontaneous pre-term birth.

Factors associated with spontaneous pre-term birth in 283 singleton pregnancies were compared with those present in a total population of 16 994 women at risk studied in the First British Perinatal Mortality Survey. It was shown that the risk of spontaneous pre-term birth was related to low maternal age, low maternal weight, maternal smoking, low social class, illegitimacy, threatened abortion, and a previous history of antepartum haemorrhage, perinatal loss, or low birth weight livebirths.

Birth Weight↗
PubMed2000

Race, clinical factors and pre-term birth in a low-income urban setting.

UNLABELLED: While infant mortality rates have declined for both White and African-American populations, the perennial two-fold excess in risk for African Americans remains unchanged, and indeed, may have increased since 1985. One potential explanation for the excess risk in African Americans might be racial differences in maternal clinical risk factors, such as prior pregnancy history and pregnancy complications. This paper examines the contributions of such clinical indicators to racial differences in pre-term delivery in a study sample of urban, low-income women, aged 18 to 43 years. METHODS: Study participants were enrolled during their first prenatal care visit at one of four hospital-based, prenatal care clinics in Baltimore City. Medical history and pregnancy outcome data were abstracted from clinical records. Multiple logistic regression models were used to assess the independent relationship between race and pre-term birth, after controlling for clinical factors. RESULTS: Without adjustment for clinical risk factors, African-American women were 1.8 times more likely than White women to have a pre-term birth outcome (95% confidence interval 1.20-2.78). After statistical adjustment for the clinical variables, however, the association between race and pre-term birth was diminished (OR = 1.64, 95% confidence interval: 0.99-2.72). Moreover, the associations between certain clinical risks and pre-term birth were stronger for African-American than White women. CONCLUSION: These results suggest that attention to clinical risk factors among African-American women may be an important avenue for reducing Black/White racial disparities in pre-term birth.

Adolescent↗
PubMed1999

Accurate prediction of term birth weight from prospectively measurable maternal characteristics.

OBJECTIVE: To determine whether accurate prediction of individual term birth weight is possible based on maternal characteristics routinely measured remote from term in healthy women. STUDY DESIGN: Two hundred sixty-two nonsmoking, nondiabetic, white gravidas with uncomplicated term gestations were studied. A cross-validated, split-sample multiple regression analysis was performed to evaluate the predictive value of seven maternal characteristics and two fetal characteristics to identify an optimal combination for accurately estimating birth weight. Fifty-nine terms were assessed for predictive accuracy. RESULTS: Significant predictors of term birth weight were gestational age, parity, fetal sex, maternal height, maternal weight and third-trimester maternal weight gain rate. Combinations of these prospectively measurable variables explained 33% of the variance in birth weight and predicted birth weight to within +/- 267 g (+/- 7.6% of individual birth weight). Term fetal macrosomia was predicted with 80% sensitivity using a prediction cutoff of 3,550 g. CONCLUSION: Individual term birth weight can be accurately predicted in normal gravidas using routinely measurable maternal characteristics. Birth weight estimates using our equation are both prospectively derivable from the beginning of the third trimester and more accurate than any previously devised algorithms, including those that incorporate fetal ultrasonographic data. Our equation can also identify pregnancies at risk for fetal macrosomia so that the timing and mode of delivery may be prospectively modified to minimize peripartum risks to both fetus and mother.

Adult↗
PubMed2001

Psychological prevention of early pre-term birth: a reliable benefit.

OBJECTIVES: After a previous study had shown the existence of psychological risk factors of pre-term delivery, we designed a study aimed at assessing the effect of psychotherapeutic support of pregnant women hospitalised with pre-term labour, followed by a second multicentric study aimed at demonstrating the reliability of such an intervention. METHODS: Both studies were conducted in two successive cohorts of patients hospitalised with pre-term labour at 18-35 weeks of gestation. The initial study comprised 157 patients in each group, whereas the reliability study comprised 191 patients in the experimental group versus 202 in the control group. In each experimental group, the patients were offered psychotherapeutic support in addition to the usual clinical management. The psychological support included interviews with a psychologist and a collaborative work plan implemented with the nursing staff. RESULTS: The analysis, conducted in the 'intention to treat' manner, shows a significant decrease in the early pre-term birth rate (< 35 weeks) from 25.7 to 5.9% (p < 0.0001). After controlling for confounding factors, the adjusted relative risk was 0.16 [95% confidence interval (CI) = 0.07-0.37]. These results were confirmed, at a lesser level, in the reliability study, where the early pre-term birth rate changed from 15.7 to 7.2% (p < 0.02) and the adjusted relative risk was 0.35 (95% CI = 0.16-0.78). CONCLUSION: This study offers new and major results related to the prevention of delivery before 35 weeks of gestation, both in the initial study as well as in the reliability study. Thus, providing this type of psychological support to women hospitalised for pre-term labour, in the context of antenatal care, can help to avoid early pre-term births and their complications in terms of brain damage and neuropsychological development.

Cohort Studies↗
PubMed1998

Accurate prediction of term birth weight from prospectively measurable maternal characteristics.

Objective: To determine whether accurate prediction of term birth weight is possible based on maternal characteristics routinely measured remote from term, and to compare this technique to more expensive methods requiring obstetrical ultrasound examinations.Methods: Two hundred fifty-nine normal, non-smoking, non-diabetic Caucasian gravidas with uncomplicated term gestations were studied. Seven maternal characteristics (age, parity, height, weight, level of obesity, rate of pregnancy weight gain, and glucose screening test result) and two fetal characteristics (fetal gender and length of gestation) were evaluated alone and in combination for their predictive values in determining birth weight. A cross-validated split-sample multiple regression analysis was used to determine which combinations of these variables were significant and a birth weight prediction equation was developed. Predictive accuracy was assessed using a jackknifing procedure, and results were compared to similar types of birthweight predictions obtained both via previous algorithms based upon maternal characteristics and those developed for use with fetal ultrasonographic biometric data.Results: Significant predictors of term birth weight were gestational age, fetal gender, parity, maternal height, maternal weight, and third trimester maternal weight gain rate. These prospectively measurable variables explained 33% of the variance in birth weight and predicted birth weight to within 10.8%. These results were compared to those obtained from other previously published algorithms and were more accurate than all others derived from either maternal characteristics or fetal ultrasonographic data. Our term birth weight prediction equation is: birth weight (g)=gestational age (days)x[9.40+0.255xgender+ 0.000232xheight (cm)xmaternal weight at 26 wk (kg)+ 4.89x3rd trimester weight gain rate (kg/d)x(parity+1)]where: gender=-1 for females;+1 for males;0 for unknown gender gestational age=conceptual age (days)+14Conclusion: Term birth weight can be accurately predicted using routinely measurable maternal characteristics. Birth weight estimates using our equation are both prospectively derivable starting from the end of the second trimester and more accurate than any previously devised algorithms, including methods based upon ultrasonographic fetal biometric data.

Journal Article↗
PubMed1997

Long term outcome after umbilical artery acidaemia at term birth: influence of gender and duration of fetal heart rate abnormalities.

OBJECTIVE: To study the outcome after acidaemia at term birth, and the relation to gender and duration of pathological fetal heart rate changes. DESIGN: Population based study of 154 infants with umbilical artery pH < 7.05 at term birth. Neonatal outcome and the result of developmental screening at age four years were compared with a control group with pH > 7.10. Fetal heart rate traces in infants with acidaemia were reviewed, and the relation between duration of fetal heart rate changes and outcome was analysed. RESULTS: Of the 154 newborns with acidaemia at birth, 10 had encephalopathy, of which two died and two developed cerebral palsy. Nine of these 10 infants were boys, and eight had pH < 7.00. Male newborns (n = 39) more often had pronounced acidaemia (pH < 7.00) than females (n = 22). Although few infants had severe impairment, infants born with acidaemia significantly more often had speech problems at follow up than controls (19/102 versus 8/98; P = 0.03). In infants with acidaemia, duration of abnormal fetal heart rate changes was significantly associated with neonatal encephalopathy and speech problems at age four years. CONCLUSIONS: Acidaemia at term birth was associated with neonatal encephalopathy and with speech problems at four years of age. Boys had more often pronounced acidaemia and a complicated course. A protracted abnormal fetal heart rate trace was associated with poor outcome.

Acidosis↗
PubMed1978

Prevention of low birth weight and pre-term birth: literature review and suggestions for research policy.

Mortality during the first week of life has greatly decreased in developed countries, but the gains have been unevenly distributed across socioeconomic groups and geographic areas. Among many explanations for these differences, low birth weight is shown to be significant in the United States, Sweden, and Finland. An imbalance between potential benefits to be gained and the paucity of experiments reporting on this is noted.

Birth Rate↗
PubMedDate not supplied

[Degree of placental maturity and histopathologic finding: clinical prospective studies of a sample of term births and premature births].

By analogy with Grannum et al.'s sonographic classification of the placenta (1979), macroscopic observation of the cut surfaces of the afterbirth enables the extent of placental segmentation to be determined and macroscopic maturity to be established in accordance with sonographic findings. Out of a total of 767 clinically-prospectively documented obstetrical cases, 674 were identified as term births and 93 as premature. For the purposes of comparison they were subdivided into two groups: term births with stage 0 to II and stage III maturity; and premature births with stage 0 to II and stage III maturity. Proceeding from this morphological classification and grouping, the clinical data, such as age of the mother, parity, gravidity, diseases during pregnancy, premature labour, type of delivery, fetal outcome, and biometric data of the newborn, as well as histologic findings regarding villous maturity, were recorded and statistically analyzed. The findings revealed no significant differences between term births with stage III maturity and those in the control group of placentas with stage 0 to II maturity and the same gestation time. Therefore, stage III maturity at term corresponds chronopathologically to a normal temporal development of fetomaternal flow units of the mature human placenta at term and does not imply any perinatological risk. Histopathologically, placentas with stage III maturity manifest a significantly advanced degree of villous maturity, with lower mean placental weight as the morphological correlate to threshold placental function, which is reflected in the clinical data of perinatological complications. Therefore, premature detection of a stage III placenta before term indicates a risk that should be kept in mind in the overall concept of prenatal monitoring parameters.

Chorionic Villi↗
PubMed1985

[Safety of term birth and cesarean birth rates].

This was a parallel of the rate of caesarean section and neurological morbidity of the term newborn. This study was performed on all infants born at a gestational age of 37 weeks or greater in 1981 and 1982 at the Baudelocque Maternity Hospital. The results show a stable caesarean section rate during these two years: 21% in 1981, 20% in 1982; as for the safety of term birth there was only one case of perinatal insult during a vaginal birth responsible for cerebral dysfunction of moderate degree. There was a 18% operative maternal morbidity and there were no deaths. We concluded that a caesarean section rate of 20% in a University Hospital is justified by the virtual absence of neonatal morbidity with an acceptable maternal risk. This rate should not increase. The possible ways of decreasing this rate, while maintaining neonatal safety, must be studied. The original aspect of this work concerns the monitoring of the caesarean section rate by the incidence of neurological complications of all term births during a fixed period of time.

Cesarean Section↗
PubMed1997

Factors affecting outcome in post-term birth.

Studies published in the past year confirm that, under current conditions of good ascertainment of gestational age and careful clinical management of post-term pregnancies, post-term births are not at increased risk of perinatal mortality. They are, however, still at increased risk of intrapartum fetal distress and cesarean birth. The main risk factor for poor fetal and neonatal outcomes is small fetal size. Risk markers for those at risk of intrapartum difficulties include amniotic fluid volume and fetal biophysical profile. While there is no longer increased mortality associated with post-term birth per se, this is very much the result of clinical selection factors and modern perinatal management. Post-term pregnancies remain an obstetrical risk group.

Amniotic Fluid↗
PubMedDate not supplied

Effects of intra-amniotic endotoxin on lung structure and function two months after term birth in sheep.

OBJECTIVE: Intra-amniotic endotoxin causes chorioamnionitis and results in improved lung function after preterm delivery in sheep. Our aim was to determine the effects on lung structure and function after term birth in lambs exposed to intra-amniotic or intra-allantoic endotoxin. METHODS: At 119 days' gestation, pregnant ewes bearing singleton fetuses received intra-amniotic or intra-allantoic injections of either saline (allantoic, n = 1; amniotic, n = 10) or Escherichia coli (055:B5) endotoxin (allantoic, n = 5; amniotic, n = 7). Amniotic or allantoic fluid was aspirated for white blood cell counts 24 hours after the injections. Ewes (n = 20) were allowed to deliver spontaneously. At 8 weeks' postnatal age we measured ventilation, lung volumes, and compliance in the offspring and collected their lungs for morphologic analysis. RESULTS: Higher amniotic or allantoic cell counts were confined to the fluid space into which endotoxin was injected. Saline injections did not increase amniotic or allantoic white blood cell counts. Gestation length, birth weight, and postnatal growth were unaffected by endotoxin treatments. Lung volumes and compliances at 8 weeks of age were not different between saline-treated and endotoxin-treated groups. Lung morphometry was not significantly altered by endotoxin, with one minor exception: interlobular septal volume was increased by intra-amniotic endotoxin, but this effect had no functional consequences. CONCLUSIONS: Intra-amniotic or intra-allantoic endotoxin caused a localized inflammatory response but did not cause preterm delivery or intrauterine growth restriction. The functional improvements and corresponding structural alterations in the lungs of preterm lambs, reported previously in this model, were not associated with improved or impaired lung function or marked alterations in lung structure 2 months after birth at term.

Aging↗
PubMed1993

Small-for-gestational-age term birth: the contribution of socio-economic, behavioural and biological factors to recurrence.

This paper follows a previous study comparing women who had repeatedly given birth to small-for-gestational-age (SGA) term infants ('repeater' mothers) with multiparous women who had had only one such infant ('non-repeater' mothers). The present investigation involves the individual matching of each woman in the above groups with a control mother whose offspring were all term non-SGA infants. The study was based on all Western Australian Caucasian women giving birth to singletons and the study population comprised 594 repeater cases with 594 matched controls and 935 non-repeater cases with 935 matched controls. Conditional logistic regression analyses indicated that demographic and paternal factors were significant predictors for recurrent SGA term birth whereas obstetric conditions, particularly preeclampsia, were important for the prediction of isolated SGA term birth. Maternal smoking, low maternal birthweight and lack of higher educational qualifications were associated with both types of SGA birth. After multivariable analyses, a strong and significant association remained between having a first infant as a teenager and recurrent SGA term birth. The tendency to repeat SGA term birth appears to be associated with social, economic and behavioural disadvantage and is unlikely to be ameliorated without fundamental changes in society.

Adolescent↗
PubMed2003

Ultrasonic prediction of term birth weight in Hispanic women. Accuracy in an outpatient clinic.

OBJECTIVE: To investigate the accuracy of ultrasonic fetal biometric algorithms for estimating term fetal weight. STUDY DESIGN: Ultrasonographic fetal biometric assessments were made in 74 Hispanic women who delivered at 37-42 weeks of gestation. Measurements were taken of the fetal biparietal diameter, head circumference, abdominal circumference and femur length. Twenty-seven standard fetal biometric algorithms were assessed for their accuracy in predicting fetal weight. Results were compared to those obtained by merely guessing the mean term birth weight in each case. RESULTS: The correlation between ultrasonically predicted and actual birth weights ranged from 0.52 to 0.79. The different ultrasonic algorithms estimated fetal weight to within +/- 8.6-15.0% (+/- 295-520 g) of actual birth weight as compared with +/- 13.6% (+/- 449 g) for guessing the mean birth weight in each case (mean +/- SD). The mean absolute prediction errors for 17 of the ultrasonic equations (63%) were superior to those obtained by guessing the mean birth weight by 3.2-5.0% (96-154 g) (P < .05). Fourteen algorithms (52%) were more accurate for predicting fetal weight to within +/- 15%, and 20 algorithms (74%) were more accurate for predicting fetal weight to within +/- 10% of actual birth weight than simply guessing the mean birth weight (P < .05). Ten ultrasonic equations (37%) showed significant utility for predicting fetal weight > 4,000 g (likelihood ratio > 5.0). CONCLUSION: Term fetal weight predictions using the majority of sonographic fetal biometric equations are more accurate, by up to 154 g and 5%, than simply guessing the population-specific mean birth weight.

Adult↗