Perinatal mortality and neonatal and maternal outcome per gestational week in term pregnancies: A registry‐based study
Abstract Introduction Human pregnancy is considered term from 37+0/7 to 41+6/7 weeks. Within this range, both maternal, fetal and neonatal risks may vary considerably. This study investigates how gestational age per week is related to the components of perinatal mortality and parameters of adverse n...
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Wiley
2023-01-01
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| Series: | Acta Obstetricia et Gynecologica Scandinavica |
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| Online Access: | https://doi.org/10.1111/aogs.14467 |
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| author | Jérôme Cornette Catharina J. van derStok Irwin K. M. Reiss René F. Kornelisse Eline van derWilk Arie Franx Yves Jacquemyn Eric A. P. Steegers Loes C. M. Bertens |
| author_facet | Jérôme Cornette Catharina J. van derStok Irwin K. M. Reiss René F. Kornelisse Eline van derWilk Arie Franx Yves Jacquemyn Eric A. P. Steegers Loes C. M. Bertens |
| author_sort | Jérôme Cornette |
| collection | DOAJ |
| description | Abstract Introduction Human pregnancy is considered term from 37+0/7 to 41+6/7 weeks. Within this range, both maternal, fetal and neonatal risks may vary considerably. This study investigates how gestational age per week is related to the components of perinatal mortality and parameters of adverse neonatal and maternal outcome at term. Material and Methods A registry‐based study was made of all singleton term pregnancies in the Netherlands from January 2014 to December 2017. Stillbirth and early neonatal mortality, as components of perinatal mortality, were defined as primary outcomes; adverse neonatal and maternal events as secondary outcomes. Neonatal adverse outcomes included birth trauma, 5‐minute Apgar score ≤3, asphyxia, respiratory insufficiency, neonatal intensive care unit admission and composite neonatal outcome. Maternal adverse outcomes included instrumental vaginal birth, emergency cesarean section, obstetric anal sphincter injury, postpartum hemorrhage, hypertensive disorders of pregnancy and composite maternal outcome. The primary outcomes were evaluated by comparing weekly prospective risks of stillbirth and neonatal death using a fetuses‐at‐risk approach. Secondly, odds ratios (OR) for perinatal mortality, adverse neonatal and maternal outcome using a births‐based approach were compared for each gestational week with all births occurring after that week. Results Data of 581 443 births were analyzed. At 37, 38, 39, 40, 41 and 42 weeks, the respective weekly prospective risks of stillbirth were 0.015%, 0.022%, 0.031%, 0.036%, 0.069% and 0.081%; the respective weekly prospective risks of early neonatal death were 0.051%, 0.047%, 0.032%, 0.031%, 0.039% and 0.035%. The OR for adverse neonatal outcomes were the lowest at 39 and 40 weeks. The OR for adverse maternal outcomes, including operative birth, continuously increased with each gestational week. Conclusions The prospective risk of early neonatal death for babies born at 39 weeks is lower than the risk of stillbirth in pregnancies continuing beyond 39+6/7 weeks. Birth at 39 weeks was associated with the best combined neonatal and maternal outcome, fewer operative births and fewer maternal and neonatal adverse outcomes compared with pregnancies continuing beyond 39 weeks. This information with appropriate perspectives should be included when counseling term pregnant women. |
| format | Article |
| id | doaj-art-d099599323704ef3961863b26da88ec5 |
| institution | OA Journals |
| issn | 0001-6349 1600-0412 |
| language | English |
| publishDate | 2023-01-01 |
| publisher | Wiley |
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| series | Acta Obstetricia et Gynecologica Scandinavica |
| spelling | doaj-art-d099599323704ef3961863b26da88ec52025-08-20T02:09:35ZengWileyActa Obstetricia et Gynecologica Scandinavica0001-63491600-04122023-01-011021829110.1111/aogs.14467Perinatal mortality and neonatal and maternal outcome per gestational week in term pregnancies: A registry‐based studyJérôme Cornette0Catharina J. van derStok1Irwin K. M. Reiss2René F. Kornelisse3Eline van derWilk4Arie Franx5Yves Jacquemyn6Eric A. P. Steegers7Loes C. M. Bertens8Department of Obstetrics and Fetal Medicine Erasmus MC Rotterdam the NetherlandsDepartment of Obstetrics and Fetal Medicine Erasmus MC Rotterdam the NetherlandsDivision of Neonatology, Department of Pediatrics Erasmus MC Rotterdam the NetherlandsDivision of Neonatology, Department of Pediatrics Erasmus MC Rotterdam the NetherlandsDepartment of Obstetrics and Fetal Medicine Erasmus MC Rotterdam the NetherlandsDepartment of Obstetrics and Fetal Medicine Erasmus MC Rotterdam the NetherlandsDepartment of Obstetrics and Gynecology University Hospital Antwerp UZA Edegem BelgiumDepartment of Obstetrics and Fetal Medicine Erasmus MC Rotterdam the NetherlandsDepartment of Obstetrics and Fetal Medicine Erasmus MC Rotterdam the NetherlandsAbstract Introduction Human pregnancy is considered term from 37+0/7 to 41+6/7 weeks. Within this range, both maternal, fetal and neonatal risks may vary considerably. This study investigates how gestational age per week is related to the components of perinatal mortality and parameters of adverse neonatal and maternal outcome at term. Material and Methods A registry‐based study was made of all singleton term pregnancies in the Netherlands from January 2014 to December 2017. Stillbirth and early neonatal mortality, as components of perinatal mortality, were defined as primary outcomes; adverse neonatal and maternal events as secondary outcomes. Neonatal adverse outcomes included birth trauma, 5‐minute Apgar score ≤3, asphyxia, respiratory insufficiency, neonatal intensive care unit admission and composite neonatal outcome. Maternal adverse outcomes included instrumental vaginal birth, emergency cesarean section, obstetric anal sphincter injury, postpartum hemorrhage, hypertensive disorders of pregnancy and composite maternal outcome. The primary outcomes were evaluated by comparing weekly prospective risks of stillbirth and neonatal death using a fetuses‐at‐risk approach. Secondly, odds ratios (OR) for perinatal mortality, adverse neonatal and maternal outcome using a births‐based approach were compared for each gestational week with all births occurring after that week. Results Data of 581 443 births were analyzed. At 37, 38, 39, 40, 41 and 42 weeks, the respective weekly prospective risks of stillbirth were 0.015%, 0.022%, 0.031%, 0.036%, 0.069% and 0.081%; the respective weekly prospective risks of early neonatal death were 0.051%, 0.047%, 0.032%, 0.031%, 0.039% and 0.035%. The OR for adverse neonatal outcomes were the lowest at 39 and 40 weeks. The OR for adverse maternal outcomes, including operative birth, continuously increased with each gestational week. Conclusions The prospective risk of early neonatal death for babies born at 39 weeks is lower than the risk of stillbirth in pregnancies continuing beyond 39+6/7 weeks. Birth at 39 weeks was associated with the best combined neonatal and maternal outcome, fewer operative births and fewer maternal and neonatal adverse outcomes compared with pregnancies continuing beyond 39 weeks. This information with appropriate perspectives should be included when counseling term pregnant women.https://doi.org/10.1111/aogs.14467adverse maternal outcomeadverse neonatal outcomeperinatal mortalitystillbirth; neonatal deathterm birth |
| spellingShingle | Jérôme Cornette Catharina J. van derStok Irwin K. M. Reiss René F. Kornelisse Eline van derWilk Arie Franx Yves Jacquemyn Eric A. P. Steegers Loes C. M. Bertens Perinatal mortality and neonatal and maternal outcome per gestational week in term pregnancies: A registry‐based study Acta Obstetricia et Gynecologica Scandinavica adverse maternal outcome adverse neonatal outcome perinatal mortality stillbirth; neonatal death term birth |
| title | Perinatal mortality and neonatal and maternal outcome per gestational week in term pregnancies: A registry‐based study |
| title_full | Perinatal mortality and neonatal and maternal outcome per gestational week in term pregnancies: A registry‐based study |
| title_fullStr | Perinatal mortality and neonatal and maternal outcome per gestational week in term pregnancies: A registry‐based study |
| title_full_unstemmed | Perinatal mortality and neonatal and maternal outcome per gestational week in term pregnancies: A registry‐based study |
| title_short | Perinatal mortality and neonatal and maternal outcome per gestational week in term pregnancies: A registry‐based study |
| title_sort | perinatal mortality and neonatal and maternal outcome per gestational week in term pregnancies a registry based study |
| topic | adverse maternal outcome adverse neonatal outcome perinatal mortality stillbirth; neonatal death term birth |
| url | https://doi.org/10.1111/aogs.14467 |
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