Optimal time of delivery to reduce the risk of infant mortality in small and normally grown fetuses: A national cohort study in Korea

PURPOSE: To examine the competing risks of stillbirth versus infant death and to evaluate the optimal time of delivery in the population of small for gestational age (SGA) and non-SGA late preterm and term fetuses. METHODS: This was a retrospective national cohort study of all singleton births betwe...

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Autores principales: Ko, Hyun Sun, Wie, Jeong Ha, Choi, Sae Kyung, Park, In Yang, Park, Yong-Gyu, Shin, Jong Chul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6294352/
https://www.ncbi.nlm.nih.gov/pubmed/30550584
http://dx.doi.org/10.1371/journal.pone.0209308
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author Ko, Hyun Sun
Wie, Jeong Ha
Choi, Sae Kyung
Park, In Yang
Park, Yong-Gyu
Shin, Jong Chul
author_facet Ko, Hyun Sun
Wie, Jeong Ha
Choi, Sae Kyung
Park, In Yang
Park, Yong-Gyu
Shin, Jong Chul
author_sort Ko, Hyun Sun
collection PubMed
description PURPOSE: To examine the competing risks of stillbirth versus infant death and to evaluate the optimal time of delivery in the population of small for gestational age (SGA) and non-SGA late preterm and term fetuses. METHODS: This was a retrospective national cohort study of all singleton births between 34 0/7 and 42 6/7 weeks of gestation using the Korean vital statistics (n = 2,106,159). We compared the risk of infant mortality with a composite of fetal–infant mortality risk that would occur after expectant management for one additional week and evaluated the optimal time of delivery, in SGA and non-SGA pregnancies. RESULTS: In the total population, the risk of expectant management became significantly higher than the risk of delivery, at 39 weeks and beyond, similar with non-SGA group. In the SGA group, the risk of stillbirth was significantly greater at all GAs than for non-SGA pregnancies, and the risk of infant death was significantly increased until 38 weeks (25.8 per 10,000 live births, 95% CI 20.11–32.47), and the risk of stillbirth was significantly increased at 41 weeks (11.65 per 10,000 ongoing pregnancies, 95% CI 6.95–18.09), compared to 39 weeks (12 per 10,000 live births, 95% CI 8.98–15.64 and 5.12 per 10,000 ongoing pregnancies, 95% CI 3.84–6.66, respectively). CONCLUSION: In Korean women, delivery between 39 and 41 weeks minimizes fetal/infant mortality, in non-SGA pregnancies. In uncomplicated SGA pregnancies, delivery between 39 and 40 weeks can be considered to decrease risk of infant death and stillbirths.
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spelling pubmed-62943522018-12-28 Optimal time of delivery to reduce the risk of infant mortality in small and normally grown fetuses: A national cohort study in Korea Ko, Hyun Sun Wie, Jeong Ha Choi, Sae Kyung Park, In Yang Park, Yong-Gyu Shin, Jong Chul PLoS One Research Article PURPOSE: To examine the competing risks of stillbirth versus infant death and to evaluate the optimal time of delivery in the population of small for gestational age (SGA) and non-SGA late preterm and term fetuses. METHODS: This was a retrospective national cohort study of all singleton births between 34 0/7 and 42 6/7 weeks of gestation using the Korean vital statistics (n = 2,106,159). We compared the risk of infant mortality with a composite of fetal–infant mortality risk that would occur after expectant management for one additional week and evaluated the optimal time of delivery, in SGA and non-SGA pregnancies. RESULTS: In the total population, the risk of expectant management became significantly higher than the risk of delivery, at 39 weeks and beyond, similar with non-SGA group. In the SGA group, the risk of stillbirth was significantly greater at all GAs than for non-SGA pregnancies, and the risk of infant death was significantly increased until 38 weeks (25.8 per 10,000 live births, 95% CI 20.11–32.47), and the risk of stillbirth was significantly increased at 41 weeks (11.65 per 10,000 ongoing pregnancies, 95% CI 6.95–18.09), compared to 39 weeks (12 per 10,000 live births, 95% CI 8.98–15.64 and 5.12 per 10,000 ongoing pregnancies, 95% CI 3.84–6.66, respectively). CONCLUSION: In Korean women, delivery between 39 and 41 weeks minimizes fetal/infant mortality, in non-SGA pregnancies. In uncomplicated SGA pregnancies, delivery between 39 and 40 weeks can be considered to decrease risk of infant death and stillbirths. Public Library of Science 2018-12-14 /pmc/articles/PMC6294352/ /pubmed/30550584 http://dx.doi.org/10.1371/journal.pone.0209308 Text en © 2018 Ko et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Ko, Hyun Sun
Wie, Jeong Ha
Choi, Sae Kyung
Park, In Yang
Park, Yong-Gyu
Shin, Jong Chul
Optimal time of delivery to reduce the risk of infant mortality in small and normally grown fetuses: A national cohort study in Korea
title Optimal time of delivery to reduce the risk of infant mortality in small and normally grown fetuses: A national cohort study in Korea
title_full Optimal time of delivery to reduce the risk of infant mortality in small and normally grown fetuses: A national cohort study in Korea
title_fullStr Optimal time of delivery to reduce the risk of infant mortality in small and normally grown fetuses: A national cohort study in Korea
title_full_unstemmed Optimal time of delivery to reduce the risk of infant mortality in small and normally grown fetuses: A national cohort study in Korea
title_short Optimal time of delivery to reduce the risk of infant mortality in small and normally grown fetuses: A national cohort study in Korea
title_sort optimal time of delivery to reduce the risk of infant mortality in small and normally grown fetuses: a national cohort study in korea
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6294352/
https://www.ncbi.nlm.nih.gov/pubmed/30550584
http://dx.doi.org/10.1371/journal.pone.0209308
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