Early Term Delivery Research Articles

Unsuspected placenta accreta spectrum at vaginal delivery: assessment of incidence, characteristics, and maternal morbidity

Placenta accreta spectrum refers to morbidly adherent trophoblastic tissue invading into the gravid uterus and is associated with significant maternal morbidity. Most cases of placenta accreta spectrum are suspected antenatally, and most patients undergo planned, late-preterm cesarean hysterectomy to reduce the risk of morbidity. Rarely, however, placenta accreta spectrum is incidentally diagnosed at vaginal delivery, but there is a scarcity of data regarding these events. This study aimed to examine the incidence, characteristics, and outcomes of pregnant individuals with incidentally diagnosed placenta accreta spectrum at term vaginal delivery. This was a retrospective cohort study investigating the Healthcare Cost and Utilization Project's National Inpatient Sample. The study population was 8,694,669 term vaginal deliveries from January 2016 to December 2019. Exclusion criteria included previous uterine scar, placenta previa, and preterm delivery. Exposure was assigned by the diagnosis of placenta accreta spectrum. The main outcomes were: (1) incidence rate, (2) clinical and pregnancy characteristics, and (3) maternal morbidity related to unsuspected placenta accreta spectrum at vaginal delivery. Multivariable binary logistic regression analysis and inverse probability of treatment weighting were fitted for statistical analysis. Unsuspected placenta accreta spectrum was reported in 1 in 3797 vaginal deliveries. In a multivariable analysis, the following were associated with increased likelihood of unsuspected placenta accreta spectrum (all, P<.05): (1) patient factor with older age, (2) uterine factors such as uterine anomaly and uterine myoma, (3) pregnancy factors including early-term delivery and previous recurrent pregnancy losses, and (4) fetal factors of in utero growth restriction and demise. Of those, uterine anomaly had the greatest association with unsuspected placenta accreta spectrum (adjusted odds ratio, 6.23; 95% confidence interval, 4.20-9.26). In a propensity score-weighted model, patients in the unsuspected placenta accreta spectrum group were more likely to have hemorrhage (65.2% vs 4.1%), blood product transfusion (21.3% vs 0.6%), hysterectomy (14.9% vs <0.1%), coagulopathy (2.9% vs 0.1%), and shock (2.9% vs <0.1%) compared with those without placenta accreta spectrum. Patients in the unsuspected placenta accreta spectrum group were also more likely to receive manual removal of the placenta compared with those in the non-placenta accreta spectrum group (25.1% vs 0.6%). This study suggests that although unsuspected placenta accreta spectrum among patients undergoing term vaginal delivery is rare, it is associated with significant morbidity. The observed association between uterine anomalies and placenta accreta spectrum warrants further investigation.

Impact of an intrapartum care quality improvement intervention in Brazilian private hospitals on care safety measures and adverse outcomes

BackgroundIn 2015, a quality improvement (QI) intervention to reduce cesarean sections (CS)—the Adequate Childbirth Project (PPA)—was implemented in the private sector in Brazil. This analysis aims to compare safety care measures and adverse outcomes between women exposed to the PPA intervention to those receiving standard care.MethodsThe analysis included a convenience sample of 12 private hospitals that participated in the PPA (2017–2018). Data collection was performed through chart review and interviews. Differences in 15 outcomes were examined using Pearson’s chi-square test and multiple logistic regressions.ResultsThe final weighted sample was comprised of 4789 births, 2570 in the PPA group (53.5%) and 2227 in the standard care group (46.5%). CS rate was significantly lower in the PPA group (67.3% vs 88.8%). After adjusting for potential confounders, PPA model was associated with decreased overall CS rate (OR = 0.30, 95% CI 0.24 to 0.36), as well as prelabor (OR = 0.41, 0.34 to 0.48) and repeated CS (OR = 0.45, 0.29 to 0.70). In terms of other safety care measures, women in the PPA model had an increased chance of absence of antibiotic prophylaxis in Group B Streptococcus (GBS) + women (OR = 4.63, 1.33 to 16.14) and for CSs (OR = 1.75, 1.38 to 2.22), while those with severe hypertension were less likely to not receiving magnesium sulphate (OR = 0.27, 0.09 to 0.77). Regarding obstetric and neonatal outcomes, PPA model was associated with a decreased chance of having an obstetric anal sphincter injury (OASI) following an episiotomy (OR = 0.34, 0.13 to 0.89), requiring antibiotics other than routine prophylaxis (OR = 0.84, 0.70 to 0.99), having a late preterm (OR = 0.36, 0.27 to 0.48) or early term baby (OR = 0.81, 0.70 to 0.94). There were no statistically significant differences for other outcomes.ConclusionsThe PPA intervention was able to reduce CS rates, late preterm and early term deliveries without increasing the chance of adverse outcomes. The bidirectional effect on safety care measures reinforces that QI initiatives includes closer observation of routine care when implementing interventions to reduce C-section rates.

American heart association (AHA) stage 1 hypertension and perinatal outcomes by gestational age at delivery

AHA stage 1 hypertension (HTN) (blood pressure [BP] 130-139/80-89mmHg on ≥2 occasions 4 hours apart < 20 weeks’ gestational age [GA]) is associated with preeclampsia, preterm and early term delivery and low birth weight. We sought to examine the association between stage 1 HTN and perinatal outcomes at term.

Risk of stillbirth in us patients with diagnosed intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is associated with a 4 to 10 fold increase in stillbirth risk without intervention, prompting recommendations for antenatal assessment, ursodiol, and often preterm or early term delivery. Whether there remains an increased rate of stillbirth due to ICP using this management strategy is unknown.

Trends in early term induction and delivery among low-risk nulliparas after the ARRIVE publication

Trends in early term induction and delivery among low-risk nulliparas after the ARRIVE publication

Revisiting the use of antenatal corticosteroids for late preterm and early term infants: An observational analytical study

Background: Guidelines from prominent policymakers on the use of antenatal steroids (ANS) in “late preterm deliveries and early term casearian deliveries” (LET) are nonuniform. This descriptive study compared LET infants born during two-time epochs: Retrospective: ANS exposed (ANSE) (when institute practice was to administer ANS to all LET mothers), and prospective – ANS unexposed (ANSU) (after the policy was revised in May 2021). Methodology: All antenatal mothers of anticipated late-preterm and early-term cesarean deliveries were being administered ANS before May 2021. Following the revision of hospital policy, this practice was discontinued. Comparative analysis for respiratory morbidity (RM) and other clinically relevant outcomes were conducted in infants born during two-time epochs (ANSE vs. ANSU) Results: Among 379 included infants, those with RMs were comparable between groups: 33 (17.5%) in ANSE; 31 (16.4%) in ANSU – Odds ratio (OR) 1.08; 95% confidence interval (CI) (0.61–1.92), P = 0.78. No difference was noted in hypoglycemia events: 23 (12.2%) in ANSE; 22 (11.6%) in ANSU, OR = 1.05 95% CI (0.56–1.96), P = 0.87. Conclusion: ANS in LET did not seem to reduce the risk of RM. It may be appropriate to audit individual unit practices and relevant outcomes before blanket recommendations are made.

Unsuspected placenta accreta spectrum at vaginal delivery: Assessment of incidence, characteristics, and maternal morbidity

To assess incidence, characteristics, and maternal morbidity related to unsuspected placenta accreta spectrum (PAS) at vaginal delivery. This is a retrospective cohort study querying the Healthcare Cost and Utilization Project’s National Inpatient Sample. The study population was 8,694,669 term vaginal deliveries from 1/2016-12/2019. Exclusion criteria included prior uterine scar (including prior cesarean delivery and myomectomy), placenta previa, and preterm delivery. Exposure was assigned by the diagnosis of PAS. The main outcomes were (i) independent characteristics assessed with multivariable binary logistic regression model and (ii) maternal morbidity assessed with inverse probability of treatment weighting. PAS was reported in one in 3,797 vaginal deliveries. In a multivariable analysis, (i) patient characteristics of older age and White race, (ii) uterine factors such as uterine anomaly and uterine myoma, (iii) pregnancy factors including early-term delivery and prior recurrent pregnancy loss, and (iv) fetal factors of in-utero growth restriction and demise were associated with increased likelihood of encountering unsuspected PAS (all, P< 0.05). Of those, uterine anomaly had the strongest association with PAS (adjusted-odds ratio [aOR] 6.23, 95% confidence interval [CI] 4.20-9.26). In a propensity score-weighted model, patients in the PAS group were more likely to have hemorrhage (65.2% vs 4.1%), blood product transfusion (21.3% vs 0.6%), performance of manual placental removal (25.1% vs 0.6%), hysterectomy (14.9% vs < 0.1%), coagulopathy (2.9% vs 0.1%), and shock (2.9% vs < 0.1%) compared to those without. The current study suggests that encountering unsuspected PAS among patients undergoing vaginal delivery with otherwise low-suspicion for PAS is rare. However, unsuspected PAS is associated with significant maternal morbidity.

Effects of relaxation therapy on maternal psychological status and infant growth following late preterm and early-term delivery: a randomized controlled trial

BackgroundMaternal stress is one modifiable variable that could influence mother–infant signaling and negatively affect breastfeeding and infant growth. ObjectivesThis study aimed to test the hypothesis that relaxation therapy would reduce maternal stress and improve infant growth, behavior, and breastfeeding outcomes after late preterm (LP) and early-term (ET) delivery. MethodsA single-blind randomized controlled trial was conducted in healthy Chinese primiparous mother–infant pairs after LP or ET delivery (34+0–37+6 gestation weeks). Mothers were randomly assigned to the intervention group (IG, listening to relaxation meditation at least once a day) or control group (CG, normal care). Primary outcomes—changes in maternal stress (perceived stress scale), anxiety (Beck Anxiety Inventory), and infant weight and length standard deviation score—were assessed at 1 wk and 8 wks postpartum. Secondary outcomes—breast milk energy and macronutrient composition, maternal breastfeeding attitudes, infant behaviors (3-d diary), and 24-hour milk intake—were assessed at 8 wks. ResultsIn total, 96 mother–infant pairs were recruited. There was a significantly greater reduction in maternal perceived stress (Perceived Stress Scale score) (mean difference [MD] = 2.65; 95% CI: 0.8, 4.5) and significantly greater infant weight standard deviation score gain (MD = 0.51; 95% CI: 0.2, 0.9) from 1 wk to 8 wks in the IG than those in the CG. Exploratory analyses showed a significant interaction between intervention and sex, with greater effects on weight gain in female infants. Mothers of female infants used the intervention more frequently with significantly higher milk energy observed at 8 wks. ConclusionsThe relaxation meditation tape is a simple, effective practical tool that could easily be used in clinical settings to support breastfeeding mothers after LP and ET delivery. The findings need confirmation in larger groups and in other populations.

Impact of restricting early-term deliveries on adverse neonatal outcomes: a statewide analysis

The "39-Week Rule" was adopted by the American College of Obstetricians and Gynecologists in 2009 to eliminate nonmedically indicated (elective) deliveries before 39 weeks in an effort to improve neonatal outcomes. Our primary objective was to quantify the effect of this policy change on adverse neonatal outcomes among a cohort of term births in South Carolina. Deidentified data from all births in the state of South Carolina from 2000 to 2008 (before the 39-week rule) and from 2013 to 2017 (after statewide implementation and enforcement of the rule) were obtained from the South Carolina Revenue and Fiscal Affairs Office. Demographic data and International Statistical Classification of Diseases and Related Health Problems Ninth/Tenth Revision codes were obtained for each birth. Our primary outcome was admission to a neonatal intensive care unit. Our secondary outcomes were respiratory morbidities (including respiratory distress syndrome and transient tachypnea of the newborn), hypoxic-ischemic encephalopathy,seizure, sepsis, birth injuries, hyperbilirubinemia, hypoglycemia, and feeding difficulties. Propensity score analysis was used to control for maternal age, body mass index, race, gestational hypertension, infection, placental abruption, and gestational and pregestational diabetes mellitus. After stratification by propensity score, the Cochran-Mantel-Haenszel test was used to compare groups. A total of 620,121 infants were liveborn at term during the 2 study periods. After implementation of the 39-week rule, there was a significant reduction in early-term deliveries. In adjusted analyses, neonatal intensive care unit admission was significantly more common in the postimplementation period. Respiratory morbidities were also significantly more common postimplementation. In contrast, there were significant reductions in birth injuries and hyperbilirubinemia in the postimplementation period. Implementation of the 39-week rule was associated temporally with an increase in adverse neonatal outcomes. The outcomes intended to be reduced by the 39-week rule, including neonatal intensive care unit admission and respiratory morbidity, seem to have increased in incidence despite adherence to the proposed guidelines.

Risk factors for respiratory distress syndrome among high-risk early-term and full-term deliveries

Objective To identify whether risk factors for respiratory distress syndrome (RDS) differ between early-term and full-term births. Study design This is a secondary analysis of a large NIH-funded retrospective cohort study including patients who delivered at a tertiary-care obstetric hospital between January 2002 and March 2013 with comorbid diabetes, hypertensive disorders, and/or fetal growth restriction (FGR). Pregnancies complicated by severe preeclampsia and multifetal gestations were excluded. Maternal characteristics, delivery information, and neonatal information were abstracted by trained clinicians blinded to the comorbidity leading to study inclusion. In this secondary analysis of the infant health outcomes of pregnancies with one or more of the qualifying conditions, risk factors for RDS among neonates born early term (37w0d–38w6d gestation) were compared to risk factors for RDS among full-term neonates (39w0d–40w6d). Results Among 10,532 singleton newborns, there were 99 cases of early-term RDS (0.94%) and 95 cases of full-term RDS (0.90%). Maternal demographics were similar between those with and without RDS in both groups. Among early-term infants, lower gestational age, presence of meconium, non-spontaneous labor, and cesarean delivery were positively associated with RDS, whereas hypertensive disorders, diabetes, FGR, and many other comorbid delivery conditions were not. The strongest risk factor for RDS among early-term infants was delivery via cesarean (RR 1.98, 95% CI 1.31, 3.01). Among full-term neonates, cesarean delivery was also positively associated with RDS, although presence of meconium, chorioamnionitis, and endometritis were all stronger risk factors with RRs >2.0. Conclusions In this cohort of high-risk term deliveries, maternal demographics and comorbidities were found not to be associated with increased risk for RDS, but novel risk factors for RDS after 37 weeks’ gestation – chorioamnionitis and endometritis – were identified. A focus on preventing infectious comorbidities may help reduce incidence of RDS at full-term. Key Points RDS risk factors vary by gestational age. Novel risk factors for RDS at full-term identified. Intrauterine inflammation associated with RDS at term.

Preterm, early term, and post-term infants from Riyadh mother and baby multicenter cohort study: The cohort profile.

BackgroundBirth before 37 or beyond 42 gestational weeks is associated with adverse neonatal and maternal outcomes. Studies investigating determinants and outcomes of these deliveries are scarce. The objective of this study was to determine the neonatal birth profile in relation to the gestational age at delivery and to evaluate its influence on the immediate maternal and neonatal outcomes.MethodsThis is a multicenter cohort study of 13,403 women conducted in three hospitals in Riyadh. Collected data included sociodemographic characteristics, obstetric history, and physical and laboratory measurements. Regression models were developed to estimate the adjusted odds ratio (OR) and confidence intervals (CI) to determine factors associated with preterm, early term, and post-term births and to evaluate common maternal and neonatal risks imposed by deliveries outside the full term.ResultsThe incidence of preterm, early term, and post-term delivery was 8.4%, 29.8%, and 1.4%, respectively. Hypertensive events during pregnancy consistently increased the risk of all grades of preterm births, from more than 3-fold for late preterm (OR = 3.40, 95% CI = 2.21–5.23) to nearly 7-fold for extremely early preterm (OR = 7.11, 95% CI = 2.24–22.60). Early term was more likely to occur in older mothers (OR = 1.30, 95% CI = 1.13–1.49), grand multiparous (OR = 1.21, 95% CI = 1.06–1.38), pregestational diabetes (OR = 1.91, 95% CI = 1.49–2.44), and gestational diabetes women (OR = 1.18, 95% CI = 1.05–1.33). The risk of post-term birth was higher in primiparous. In preterm births, the adverse outcome of neonates having an APGAR score of <7 at 5 min and admission to neonatal intensive care units increased progressively as the gestational age decreased. Post-term births are 2-fold more likely to need induction of labor; meanwhile, preterm births were more likely to deliver by cesarean section.ConclusionThis large cohort study was the first in Saudi Arabia to assess the delivery profile across a continuum of gestational age and the associated maternal and neonatal adverse outcomes of deliveries outside the full-term period. The study showed that the prevalence of preterm and post-term birth in Saudi Arabia is similar to the prevalence in other high-income countries. The immediate adverse pregnancy outcomes inversely increased with the decrease in gestational age at delivery. In addition, maternal age, hypertension, diabetes, and parity influenced the gestational age at delivery.

Delivery timing for the opioid–exposed infant

The prevalence of opioid use disorder and medication-assisted treatment in pregnancy is increasing. Compared with term infants, preterm infants have a lower incidence of neonatal opioid withdrawal syndrome. It is unknown whether early term delivery compared with full or late-term delivery decreases the risk of neonatal opioid withdrawal syndrome. This study aimed to compare the neonatal outcomes among opioid-exposed infants born in the early, full, and late-term periods. This was a retrospective cohort study of opioid-exposed pregnancies delivering at a single center from 2010 to 2017 at ≥37 weeks gestation. Participants with multiple gestations or fetal anomalies were excluded. Maternal opioid exposurewas defined as prescription (including medication-assisted treatment) or nonprescription opioid use or a positive urine drug screen in pregnancy for opiates. The primary outcome was a neonatal composite of respiratory distress syndrome, neonatal sepsis, neonatal seizures, hypoxic ischemic encephalopathy, jaundice requiring treatment, 5-minute Apgar <5, neonatal intensive care unit admission, neonatal opioid withdrawal syndrome, or neonatal death. The secondary outcomes included individual components of the primary outcome, birthweight, need for and length of neonatal opioid withdrawal syndrome treatment, length of hospital admission, and maximum Finnegan scores. Early (37-<39), full (39-<41), and late (41-<42 weeks) term groups were defined by the American College of Obstetricians and Gynecologists. Of 399 infants, 136 (34.1%), 229 (57.4%), and 34 (8.5%) were born in the early, full, and late-term periods, respectively. Two hundred and seventy patients (67.7%) received medication-assisted treatment for opioid use disorder, and the baseline characteristics were similar in all the groups except for history of intranasal heroin use, positive urine toxicology screen for heroin or any opiates, and delivery indication (P<.05). The primary composite outcome occurred in 313 (78.4%) neonates, and 296 (74.2%) neonates had neonatal opioid withdrawal syndrome. More than half (219 [54.9%]) of opioid-exposed neonates were admitted to the neonatal intensive care unit, and 160 (40.1%) required pharmacologic neonatal opioid withdrawal syndrome treatment for a mean duration of almost 3 weeks (19.0±16.1 days). There were no significant differences in the primary composite outcome, incidence of neonatal opioid withdrawal syndrome, or other secondary outcomes (except birthweight) between neonates born in the early, full, or late-term periods. Although neonatal morbidity was frequent among opioid-exposed neonates, the incidence and severity of neonatal opioid withdrawal syndrome or other neonatal outcomes were not different between neonates delivered in the early, full, and late-term periods, suggesting that opioid-exposed infants may not benefit from early term delivery.

Trends in gestational age at delivery for intrahepatic cholestasis of pregnancy and adoption of society guidelines

Intrahepatic cholestasis of pregnancy is associated with a significant risk of stillbirth, which contributes to variation in clinical management. Recent Society for Maternal-Fetal Medicine guidance recommends delivery at 36 weeks of gestation for patients with serum bile acid levels of >100 μmol/L, consideration for delivery between 36 and 39 weeks of gestation stratified by bile acid level, and against preterm delivery for those with clinical features of cholestasis without bile acid elevation. This study aimed to investigate institutional practices before the publication of the new delivery timing recommendations to establish the maternal and neonatal effects of late preterm, early-term, and term deliveries in the setting of cholestasis. This study examined maternal and neonatal outcomes of 441 patients affected by cholestasis delivering 484 neonates in a 4-hospital system over a 30-month period. Logistic and linear regression analyses were performed to assess neonatal outcomes concerning peak serum bile acid levels at various gestational ages controlling for maternal comorbidities, multiple pregnancies, and neonatal birthweight. With the clinical flexibility afforded by the new guidelines, pregnancy prolongation to term may have been achieved in 91 patients (21%), and 286 patients (74%) with bile acid elevation could have delivered at a later gestational age. Preterm deliveries of patients with bile acid levels of >10 μmol/L were associated with higher rates of neonatal intensive care unit admission and adverse neonatal outcomes than early-term deliveries. Study data suggested an opportunity for education and practice change to reflect current Society for Maternal-Fetal Medicine guidelines in efforts to reduce potential neonatal morbidities associated with late preterm deliveries among pregnancies affected by cholestasis.

Pre and Post-Lockdown Cesarean Deliveries and Perinatal Quality Indicators During the COVID-19 Pandemic.

We examined statewide perinatal quality indicators: nulliparous singleton term vertex cesarean births (NTSV) or low risk cesarean births, and non-medically indicated early term delivery (NMETD) rates during COVID-19 pandemic pre-lockdown (1/1/2019 to 3/23/2020) and post-lockdown (after 3/23/2020). Interrupted time-series analyses were used to examine the effects of the COVID-19 pandemic on these indicators. We observed a statistically significant increase in NTSV cesarean rates, 4.4% (95%CI: 1.3,7.4) immediately after lockdown, and a decrease in NMETD rate, 1.6% (95%CI: -2.5,-0.7). We observed an increase (0.3%; 95%CI: 0.0,0.6) in the slope (i.e., trend change) of NTSV rates post-lockdown and a decrease (-0.2%; 95%CI: -0.3,-0.1) in the slope of NMETD rates. Results suggest that the COVID-19 pandemic had an immediate effect on perinatal quality indicators in Delaware, with gradual return to pre-pandemic rates as the pandemic continued. In addition to emergency preparedness planning, hospital monitoring of perinatal quality indicators might improve obstetrical care during public health emergencies.

Antenatal Detection of True Knot in the Umbilical Cord - How Accurate Can We Be?

Umbilical cord knot (UCK) is associated with increased risk of fetal death, but is usually diagnosed only after delivery. Our objective was to examine the accuracy of prenatal ultrasound in the diagnosis of UCK and the outcomes of these pregnancies. A prospective study was performed on 56 patients in which UCK was suspected during a routine level-II anatomical scan (study group). Data included demographics, pregnancy outcome, and short-term neonatal follow-up. The control group included pregnant women with normal pregnancy without UCK in a 4:1 ratio matched for gestational age at delivery. True knot was observed postnatally in 54 out of 56fetuses (detection rate of 96.4 %). Gestational age at diagnosis of UCK was 22.1 ± 3.1 weeks. The female to male ratio was 1:1 in both groups. Maternal age and parity were significantly higher in pregnancies with UCK compared to controls. The mean gestational age at delivery was 37.1 weeks of gestation in the UCK group. There was no difference in the birthweight percentile. 47 patients (87 %) underwent induction of labor. There were no differences in the rate of cesarean section or Apgar scores. No neonate with UCK needed ventilation. None suffered from seizures and none needed brain imaging. There were no cases of fetal or neonatal death in the pregnancies with UCK. There is a high detection rate of UCK during targeted scan of the umbilical cord performed during the level-II anatomical scan. Careful pregnancy follow-up and early term delivery may result in excellent obstetrical outcomes.

A Comparative Study of Neonatal Outcome in Early-Term Neonates versus Full-Term Neonates in a Tertiary Care Hospital in North India

Background: Neonatal morbidity due to physiologic immaturity has been extensively studied in preterm infants delivered in less than 37 weeks gestation. However, evidence indicates that the infants delivered between 37+0 and 38+6 weeks gestation are also at increased risk for morbidity compared with the infants delivered at 39+0 to 40+6 weeks. Methodology: The present hospital-based prospective observational study was conducted among 150 neonates [75 babies each of early term (37+0 to 38+6 weeks) and full term (39+0 to 40+6 weeks)], born to consenting mothers in a tertiary care referral and teaching hospital, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly. Apart from maternal demographic and obstetric factors, features of the newborn - APGAR score at 1 &amp; 5 minutes, admission to NICU, and other morbidity indicators such as respiratory distress, hyperbilirubinemia, neonatal sepsis, and prolonged hospital stay (&gt;7 days), etc were recorded and compared. SPSS v21.0 was used for statistical analysis. Results: The mean age of mothers was 25.27+3.93 years (age range 19-40 years). Early term deliveries were common among older age groups, and full term among younger ones. Full term neonates had a higher APGAR 1-minute score than early term (p = 0.049), but this difference was not significant at 5-minute score (p &gt; 0.05). NICU admission, respiratory distress and jaundice were more common among early term as compared to full term neonates (*p &lt; 0.05). Conclusion: Early term neonates have a significantly higher morbidity and distress as compared to full term neonates. Studies are recommended to develop strategies to reduce early delivery of high-risk pregnancies.

Advances in Stroke: Stroke in Women.

Advances in Stroke: Stroke in Women.

Long-Term Endocrine and Metabolic Outcomes in Early Term Born Offspring: A Systematic Review and Meta-Analysis

Childhood endocrine and metabolic morbidity is a major global public health concern, with rising prevalence. Prematurity clearly impacts the long-term risk for such morbidity. We sought to systematically review the literature and evaluate whether early-term deliveries (370/7-386/7 weeks of gestation) impact the long-term endocrine and metabolic health of offspring up to the age of 18 years, as compared to offspring born at full term or later. This systematic review and meta-analysis was conducted according to the PRISMA guidelines and was registered in PROSPERO. We searched Medline, Embase, and relevant reference lists up to November 8th, 2020, including observational studies addressing the association. Two independent reviewers extracted data and assessed risk of bias. Pooled odds ratios (ORs) with their 95% confidence intervals (95% CIs) and heterogeneity were determined. Publication bias was assessed by Funnel plots with Eggers regression line and contours, and sensitivity analyses were performed using Baujat plots. Seven studies were included following a screen of over 5000 abstracts. Five studies were scored high quality according to the Newcastle-Ottawa Quality Assessment Scale. Early term delivery significantly increased the risk of total endocrine and metabolic morbidity in the offspring (OR=1.12, 95%CI=1.08, 1.17) as compared to full term delivery (Figure 1). The increased endocrine morbidity was mainly attributed to childhood diabetes (OR=1.14, 95%CI=1.09, 1.19) (Figure 2). Compared with full term born offspring, early term delivery poses a significant risk for long-term pediatric endocrine and metabolic morbidity. This association may be due to lack of full maturity of the hormonal axis in early term born children.

Optimal Timing of Delivery in Women with History of Stillbirth: A Decision Analysis

Patients with prior stillbirth have increased risk of subsequent stillbirth, with odds ratio 3.2 for previous unexplained stillbirth. This study sought to determine optimal timing of delivery in pregnancies with prior stillbirth by accounting for common neonatal morbidities associated with late preterm and early term delivery.

Delivery timing for the opioid-exposed infant

The prevalence of opioid use disorder and medication assisted treatment (MAT) in pregnancy is increasing. Compared to term infants, preterm infants have a lower incidence of neonatal opioid withdrawal syndrome (NOWS). It is unknown whether early term delivery, compared to full or late term, decreases risk of NOWS. Our objective was to compare neonatal outcomes among opioid-exposed infants born in the early, full and late-term periods.