Abstract
BackgroundTo investigate perinatal decision-making and the use of obstetric interventions, we examined the effects of antenatal steroids, tocolysis, and delivery mode on birth in a good condition (defined as presence of an infant heart rate >100 at five minutes of age) and delivery-room (DR) death in extremely preterm deliveries.MethodsProspective cohort of all singleton births in England in 2006 at 22–26 weeks of gestation where the fetus was alive at the start of labour monitoring or decision to perform caesarean section. Odds ratios adjusted for potential confounders (aOR) were calculated using logistic regression.ResultsOne thousand seven hundred twenty two singleton pregnancies were included. 1231 women received antenatal steroids, 437 tocolysis and 356 delivered by Caesarean section. In babies born vaginally, aOR between a partial course of steroids and improved condition at birth was 1.84, 95% CI: 1.20 to 2.82 and, for a complete course, 1.63, 95% CI: 1.08 to 2.47; for DR death, aORs were 0.34 (0.21 to 0.55) and 0.41 (0.26 to 0.64) for partial and complete courses of steroids. No association was seen for steroid use in babies delivered by Caesarean section. Tocolysis was associated with improved condition at birth (aOR 1.45, 95% CI: 1.05 to 2.0) and lower odds of death (aOR 0.48, 95% CI: 0.32 to 0.73). In women without spontaneous labour, Caesarean delivery at ≤24 and 25 weeks was associated with improved condition at birth ((aORs 12.67 (2.79 to 57.60) and 4.94 (1.44 to 16.90), respectively) and lower odds of DR death (aORs 0.03 (0.01 to 0.21) and 0.13 (0.03 to 0.55)). There were no differences at 26 weeks gestation or in women with spontaneous labour.ConclusionsAntenatal steroids are strongly associated with improved outcomes in babies born vaginally. Tocolysis was associated with improvements in all analyses. Effects persisted after adjustment for perinatal decision-making. However, associations between delivery mode and birth outcomes may be attributable to case selection.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1154-y) contains supplementary material, which is available to authorized users.
Highlights
To investigate perinatal decision-making and the use of obstetric interventions, we examined the effects of antenatal steroids, tocolysis, and delivery mode on birth in a good condition and delivery-room (DR) death in extremely preterm deliveries
We evaluated the relationship of three specific perinatal interventions – antenatal steroids, tocolysis and delivery by Caesarean section – to the chances of the baby being born in a good condition and to death in the delivery-room (DR)
Of the five items relating to counselling, 1,495 responses provided some indication that counselling had occurred, including 351 cases where a decision was made not to perform emergency Caesarean section in cases of fetal distress, 465 women with whom withholding care was discussed and 727 who expressed a choice regarding provision of resuscitation to and intensive care to a live born baby; 1,287 women were counselled by a senior obstetrician and 1,246 by a paediatrician (Additional file 1: Figure S2)
Summary
To investigate perinatal decision-making and the use of obstetric interventions, we examined the effects of antenatal steroids, tocolysis, and delivery mode on birth in a good condition (defined as presence of an infant heart rate >100 at five minutes of age) and delivery-room (DR) death in extremely preterm deliveries. In certain clinical situations, delaying delivery may be beneficial at such low gestational ages, EPICure 2 is a whole population study of extremely preterm births to women resident in England in 2006. Evaluation of risk factors at birth in those admitted to neonatal units in 1995 identified the baby born after use of antenatal steroids whose heart rate was greater than 100 beats per minute (bpm) at 5 min after birth as more likely to survive and to have less long term morbidity [4, 5]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
