Preterm Gestation Research Articles

Bone mineral density in very low birthweight adults-A sibling study.

BackgroundChildren and adults born very low birthweight (VLBW, <1500 g) at preterm gestations have lower bone mineral density (BMD) and/or bone mineral content (BMC) than those born at term, but causality remains unknown.ObjectivesOur aim was to assess BMD and BMC in adults born at VLBW in a sibling comparison setting to account for shared genetic and environmental confounders.MethodsWe conducted a cohort study of 77 adults born VLBW and 70 same‐sex term‐born siblings at mean age of 29 years. The primary outcome variables were BMD Z‐scores, and BMC, of the femoral neck, lumbar spine, and whole body, measured using dual‐energy X‐ray absorptiometry. We analysed data by linear mixed models.ResultsThe VLBW adults had a 0.25 (95% CI 0.02, 0.47) Z‐score unit lower femoral neck BMD, and 0.35 (95% CI 0.16, 0.54) grams lower femoral neck BMC than their term‐born siblings, after adjustment for sex, age, and maternal smoking. Additional adjustment for adult body size attenuated the results. Lumbar spine, and whole body BMC were also lower in the VLBW group.ConclusionsIndividuals born at VLBW had lower BMC values at all three measurement sites, as well as lower femoral neck BMD Z‐scores, compared to term‐born siblings, partly explained by their smaller adult body size, but the differences were smaller than those reported previously with unrelated controls. This suggests that genetic or environmental confounders explain partly, but not exclusively, the association between preterm VLBW birth and adult bone mineralisation.

The impact of the Antenatal Late Preterm Steroids trial on the administration of antenatal corticosteroids

In 2016 the Antenatal Late Preterm Steroids study was published, demonstrating that antenatal corticosteroid therapy given to women at risk of late preterm delivery reduces respiratory morbidity in infants. However, the administration of antenatal corticosteroid therapy in late-preterm infants remains controversial. Late-preterm infants do not suffer from the same rates of morbidity as early-preterm infants, and the short-term benefits of antenatal corticosteroid therapy are less pronounced; consequently, the risk of possible harm is more difficult to balance. This study aimed to evaluate the association between the publication of the Antenatal Late Preterm Steroids study or the subsequent changes in guidelines and the rates of antenatal corticosteroid therapy administration in late-preterm infants in the United States. Data analyzed were publicly available US birth certificate data from January 1, 2016 to December 31, 2018. An interrupted time series design was used to analyze the association between publication of the Antenatal Late Preterm Steroids study and changes in monthly rates of antenatal corticosteroid administration in late preterm gestation (34+0 to 36+6 weeks). Births at 28+0 to 31+6 weeks' gestation were used as a control. Antenatal corticosteroid therapy administration in women with births at 32+0 to 34+6 weeks was explored to analyze whether the intervention influenced antenatal corticosteroid therapy administration in women in the subgroup approaching 34 weeks' gestation. Antenatal corticosteroid therapy administration in women with term births (>37 weeks' gestation) was analyzed to explore if the intervention influenced the number of term babies exposed to antenatal corticosteroid therapy. Our regression model allowed analysis of both step and slope changes. February 2016 was chosen as the intervention period. Our sample size was 18,031,950 total births. Of these, 1,056,047 were births at 34+0 to 36+6 weeks' gestation, 123,788 at 28+0 to 31+6 weeks, 153,708 at 32 to 33 weeks, and 16,602,699 were term births. There were 95,708 births at <28 weeks' gestation. There was a statistically significant increase in antenatal corticosteroid therapy administration rates in late preterm births following the online publication of the Antenatal Late Preterm Steroids study (adjusted incidence rate ratio, 1.48; 95% confidence interval, 1.36-1.61; P=.00). A significant increase in antenatal corticosteroid therapy administration rates was also seen in full-term births following the online publication of the Antenatal Late Preterm Steroids study. No significant changes were seen in antenatal corticosteroid administration rates in gestational age groups of 32+0 to 33+6 weeks or 28+0 to 31+6 weeks. Online publication of the Antenatal Late Preterm Steroids study was associated with an immediate and sustained increase in the rates of antenatal corticosteroid therapy administration in late preterm births across the United States, demonstrating a swift and successful implementation of the Antenatal Late Preterm Steroids study guidance into clinical practice. However, there is an unnecessary increase in full-term infants receiving antenatal corticosteroid therapy. Given that the long-term consequences of antenatal corticosteroid therapy are yet to be elucidated, efforts should be made to minimize the number of infants unnecessarily exposed to antenatal corticosteroid therapy.

Antenatal factors for neonatal seizures among late preterm births**

Objective The objective of this study was to evaluate for antenatal risk factors for neonatal seizures among late preterm births. Study design This was a case control study which included late preterm births without anomaly from the United States Natality database. Cases were infants with neonatal seizures, while the controls consisted of infants without neonatal seizures. Maternal and pregnancy characteristics were compared. Multivariable logistic regression was performed to investigate risk factors for neonatal seizures. Results Of the 943,580 late preterm births, 512 (0.05%) developed neonatal seizures. Significant risk factors associated with neonatal seizures among late preterm births included number of prenatal visits (adjusted odds ratio [aOR] 0.94, 95% CI [0.92–0.96]), smoking history (aOR 1.78, 95% CI [1.41–2.25]), chorioamnionitis (aOR 4.37, 95% CI [2.65–7.21]), non-Hispanic White race (aOR 1.41, 95% CI [1.13–1.76]), and cesarean birth (aOR 2.31, 95% CI [1.91–2.80]). Conclusion Number of prenatal visits, history of smoking, chorioamnionitis, non-Hispanic white race, and cesarean birth are risk factors for neonatal seizures at late preterm gestation.

Causes of perinatal deaths in Australia: Slow progress in the preterm period.

AimThe majority of perinatal deaths occur in the preterm period; however, current approaches predominantly focus on prevention in the term period. Reducing perinatal deaths in the preterm period is, therefore, key to reducing the rates of perinatal death overall in Australia. The aim was to understand the classifications of causes of preterm stillbirth and neonatal death in Victoria over time and by gestation.Materials and methodsRetrospective study using state‐wide, publicly available data. All births in Victoria between 2010 and 2018 included in the Victorian Perinatal Data Collection, excluding terminations of pregnancy for maternal psychosocial indications, were studied. Differences in causes of preterm perinatal mortality gestation group and over time were determined.ResultsOut of 7977 perinatal deaths reported, 85.9% (n = 6849) were in the preterm period. The most common cause of preterm stillbirths was congenital anomalies (n = 1574, 29.8%), followed by unexplained antepartum deaths (n = 557, 14.2%). The most common cause of preterm neonatal death was spontaneous preterm birth (sPTB; n = 599, 38.2%), followed by congenital anomalies (n = 493, 31.4%). The rate of preterm stillbirths due to hypertension (−14.9% (95% CI −27.1% to −2.7%; P = 0.02)), maternal conditions (−24.1% (95% CI −44.2% to −4.0%; P = 0.03)) and those that were unexplained (−5.4% (95% CI −9.8% to −1.2%; P = 0.02)) decreased per annum between 2010 and 2018. All other classifications did not change significantly over time.ConclusionPrevention of congenital anomalies and sPTB is critical to reducing preterm perinatal mortality. Greater emphasis on understanding causes of preterm deaths through mortality investigations may reduce the proportion of those considered ‘unexplained’.

Innovative computational approaches shed light on genetic mechanisms underlying cognitive impairment among children born extremely preterm

BackgroundAlthough survival rates for infants born extremely preterm (gestation < 28 weeks) have improved significantly in recent decades, neurodevelopmental impairment remains a major concern. Children born extremely preterm remain at high risk for cognitive impairment from early childhood to adulthood. However, there is limited evidence on genetic factors associated with cognitive impairment in this population.MethodsFirst, we used a latent profile analysis (LPA) approach to characterize neurocognitive function at age 10 for children born extremely preterm. Children were classified into two groups: (1) no or low cognitive impairment, and (2) moderate-to-severe cognitive impairment. Second, we performed TOPMed-based genotype imputation on samples with genotype array data (n = 528). Third, we then conducted a genome-wide association study (GWAS) for LPA-inferred cognitive impairment. Finally, computational analysis was conducted to explore potential mechanisms underlying the variant x LPA association.ResultsWe identified two loci reaching genome-wide significance (p value < 5e-8): TEA domain transcription factor 4 (TEAD4 at rs11829294, p value = 2.40e-8) and syntaxin 18 (STX18 at rs79453226, p value = 1.91e-8). Integrative analysis with brain expression quantitative trait loci (eQTL), chromatin conformation, and epigenomic annotations suggests tetraspanin 9 (TSPAN9) and protein arginine methyltransferase 8 (PRMT8) as potential functional genes underlying the GWAS signal at the TEAD4 locus.ConclusionsWe conducted a novel computational analysis by utilizing an LPA-inferred phenotype with genetics data for the first time. This study suggests that rs11829294 and its LD buddies have potential regulatory roles on genes that could impact neurocognitive impairment for extreme preterm born children.

Antenatal corticosteroid administration and attention-deficit/hyperactivity disorder in childhood: a regression discontinuity study.

Background:Antenatal corticosteroids reduce respiratory morbidity in preterm infants, but their use during late preterm gestation (34–36 weeks) is limited because their safety for longer-term child neurodevelopment is unclear. We sought to determine if fetuses with higher probability of exposure to antenatal corticosteroids had increased rates of prescriptions for attention-deficit/hyperactivity disorder (ADHD) medication in childhood, using a quasiexperimental design that better controls for confounding than existing observational studies.Methods:We identified 16 358 children whose birthing parents were admitted for delivery between 31 + 0 (31 weeks, 0 days) and 36 + 6 weeks’ gestation in 2000–2013, using a perinatal data registry from British Columbia, Canada, and linked their records with population-based child ADHD medication data (2000–2018). We used a regression discontinuity design to capitalize on the fact that pregnancies presenting for delivery immediately before and immediately after the clinical cut-off for antenatal corticosteroid administration of 34 + 0 weeks’ gestation have very different levels of exposure to corticosteroids, but are otherwise similar with respect to confounders.Results:Over a median follow-up period of 9 years, 892 (5.5%) children had 1 or more dispensations of ADHD medication. Children whose birthing parents were admitted for delivery just before the corticosteroid clinical cut-off of 34 + 0 weeks’ gestation did not appear to be more likely to be prescribed ADHD medication than those admitted just after the cut-off (rate ratio 1.1, 95% confidence interval [CI] 0.8 to 1.6; 1.3 excess cases per 100 children, 95% CI −2.5 to 5.7).Interpretation:We found little evidence that children with higher probability of exposure to antenatal corticosteroids have higher rates of ADHD prescriptions in childhood, supporting the safety of antenatal corticosteroids for this neurodevelopmental outcome.

Correlation Preterm Infants Gestational Age and Birth Weight at one Medical Center at Banyumas Regency Indonesia

Introduction: Preterm infants commonly experience with low birth weight. Identifying preterm infants’ gestational age and birth weight is pivotal to prevent intra uterine growth retardation and prevent case of LBW infants. Aims: To clarify the correlation between preterm infants’ gestational age and birth weight. Methods: An observational study involving a convenience samples of 46 preterm infants who were born less than 37 weeks gestation were taken from level 1, 2, and 3 neonatal care at one medical center at Banyumas Regency, Indonesia. Data were retrieved from infants’ medical record using a self-designed collection data sheet. Data were analyzed using univariate, Shapiro Wilk, and Spearman Rank test. Result: The preterm infants gestation age had moderate positive correlation with birthweight (r=.490, p= 0.01, n=46). Conclusion: Increasing the maturity of preterm infants’ gestation will effect on the increased of birth weight. It means that health care professional should give health education to mothers to reduce the high risk for preterm infants’ delivery and reduce the risk of LBW infants

Association between cesarean section rate and maternal age in twin pregnancies

To evaluate the effect of maternal age to the cesarean section rate of twin pregnancies in late preterm and term gestation. A retrospective study was performed on twin pregnancies delivered at Seoul National University Bundang Hospital from June 2003 to December 2020. Preterm births before 34weeks of gestation were excluded, and only live births were analyzed. The patients were classified into four groups according to maternal age (<30, 30-34, 35-39, and≥40 years). The primary outcome was the rate of cesarean section. The median value of maternal body mass index, the rate of assisted reproductive technology, dichorionic twin pregnancy, preeclampsia, and gestational diabetes increased significantly according to the maternal age group (all p<0.05). Among a total of 2,075 twin pregnancies, the rates of cesarean section were 65, 74, 80, and 95% for groups with maternal age under 30, 30-34, 35-39, and≥40 years, respectively (p<0.001). The cesarean section rates after a trial of labor were 22, 22, 28, and 63%, respectively (p=0.032). Maternal old age was an independent risk factor for cesarean section after a trial of labor in both nulliparous and multiparous women after adjusting for confounding factors. The rate of cesarean section in twin pregnancies significantly increased as maternal age increased, even in multiparous women.

The effects of placental transfusion on mothers

Objective While there is ample evidence supporting delayed cord clamping (DCC) in neonates, the data on the maternal outcomes related to DCC are relatively sparse. Moreover, the outcomes, such as postpartum hemorrhage (PPH), were mostly reported for uncomplicated term vaginal deliveries. The objective of this study was to present the two primary maternal outcomes, incidence of PPH and change in hematocrit pre- and post-delivery in complex situations of preterm deliveries and term cesarean sections. Study design Maternal data were collected prospectively since the placental transfusion process was implemented in a step-wise fashion in our delivery hospitals, starting August, 2013. These data on very preterm singleton, moderate preterm, very preterm twin gestation, late preterm deliveries and term cesarean sections with DCC or umbilical cord milking (UCM) were compared with respective retrospective cohorts of deliveries in which immediate cord clamping (ICC) was performed. Results Comparing very preterm singleton deliveries, the incidence of PPH was similar between the ICC and DCC groups (2.3% vs. 1.7%). There was no significant difference in mean hematocrit change pre- and postdelivery (3.06 ± 1.32 vs. 3.47 ± 1.52). When 45 s DCC cohort was compared with 60 s DCC cohort, there were no significant differences in the incidence of PPH (1.7% vs. 4.8%) or the hematocrit change pre- and postdelivery (3.47 ± 1.52 vs. 4.32 ± 1.88). PPH was not observed in either group when comparing retrospective ICC cohort with prospective DCC cohort with 60 s delay in very preterm twin gestation deliveries. There was no significant difference between the mean hematocrit change pre- and postdelivery (5.5 ± 3.3 vs. 5.8 ± 3.9). When moderate and early late preterm deliveries between 32° to 346 weeks of gestation were compared, there were no differences between the incidence of PPH (0.9% vs. 0%) or hematocrit change pre- and postdelivery (4.2 ± 2.3 vs. 4.8 ± 2.9). Comparing late preterm deliveries between 35° and 366 weeks of gestation, there was no significant difference in the incidence of PPH (13% vs. 11.4%) or the mean hematocrit change pre- and postdelivery (5.0 ± 3.0 vs. 5.1 ± 2.8). In term cesarean deliveries, the incidence of PPH was 2.2% in the retrospective ICC group and 1.4% in the prospective UCM group. There was no difference in mean hematocrit change pre- and postdelivery (5.9 ± 3.7 vs. 6.2 ± 2.8). Conclusion DCC or UCM was not associated with the increased risk for PPH or significant change in maternal hematocrit pre- and postdelivery in very preterm singleton, moderate preterm, very preterm twin gestation, late preterm deliveries and term cesarean sections.

Preterm twin gestation: The association between severity of small for gestational age and neonatal outcomes

Twin gestations account for a substantial proportion of preterm, small for gestational age (SGA) neonates. Evidence is limited on SGA severity and outcomes by twin status and birth order. We investigated the associations between SGA severity and birth outcomes among twins using a contemporary, population-based cohort.

Clinical implications of preterm infant gut microbiome development.

Perturbations to the infant gut microbiome during the first weeks to months of life affect growth, development and health. In particular, assembly of an altered intestinal microbiota during infant development results in an increased risk of immune and metabolic diseases that can persist into childhood and potentially into adulthood. Most research into gut microbiome development has focused on full-term babies, but health-related outcomes are also important for preterm babies. The systemic physiological immaturity of very preterm gestation babies (born earlier than 32 weeks gestation) results in numerous other microbiome-organ interactions, the mechanisms of which have yet to be fully elucidated or in some cases even considered. In this Perspective, we compare assembly of the intestinal microbiome in preterm and term infants. We focus in particular on the clinical implications of preterm infant gut microbiome composition and discuss the prospects for microbiome diagnostics and interventions to improve the health of preterm babies.

Postpartum anemia and hematologic recovery in pre-term gestation deliveries

Given physiologic blood volume expansion in pregnancy, the objective of this study is to assess the effect of gestational age at delivery on postpartum anemia and hematologic recovery in the postpartum period.

Evaluation of Risk Factors and Approach to Screening for Asymptomatic Neonatal Hypoglycemia

Introduction: Protocols to identify asymptomatic neonatal hypoglycemia (NH) rely on the presence of established risk factors (late preterm gestation, large or small for gestational age, and infant of a diabetic mother) for inclusion. We analyzed the performance of these risk factors in identifying hypoglycemia in modern practice, and additionally evaluated the optimal duration of screening blood glucose measurements. Methods: We analyzed a retrospective cohort of 830 infants with 1 or more known risk factor(s) for NH admitted to the mother-baby unit of a single tertiary-care center from May 2017 to April 2018. Manual chart review was performed for data extraction and confirmation of risk factor(s). Infants were excluded if glucose measurements were obtained for any reason other than screening for asymptomatic NH. Results: Of the 830 included infants, 31 (3.7%) ultimately received intravenous dextrose (IVD). Most screened infants (n = 510, 61.4%) did not develop hypoglycemia. None of the established risk factors showed strong association with hypoglycemia. Cesarean delivery was associated with hypoglycemia, although not strongly. All infants who received IVD for feeding-refractory hypoglycemia were identified by the first 2 measurements with nearly all (30/31, 97%) identified at the initial measurement. Conclusions: Currently accepted risk factors are limited in their ability to identify infants who subsequently develop hypoglycemia, and as a result, most screened infants do not develop hypoglycemia. The majority of infants in our cohort who did develop hypoglycemia achieved normoglycemia with feeding-based interventions and did not require IVD. Those that received IVD were more likely to develop hypoglycemia early and to a more severe degree. Together, our data suggest further refinement of protocol duration and risk factors utilized for screening as potential areas of screening protocol optimization.

Perinatal Outcome of Second Twin in Third Trimester of Pregnancy.

With increasing trend of twin pregnancy and along with increasing advancement in neonatal care, survival rate of twin pregnancy has increased. However there is worse perinatal outcome in second twin in comparison with the first twin. Hospital based observational cross-sectional study of 42 pregnant women with twin pregnancy at Paropakar Maternity and Women's Hospital was conducted from November 2019 to October 2020. The outcome of second twin was assessed in relation to gestational age, chorionicity, mode of delivery, delivery interval. McNemar test was used for analysis with 0.05 as the level of significance. Among 42 pair of twins, Apgar score of the second twin was found to be lower than the first twin (p=0.00) in general and in preterm gestation (p=0.115). Among twin who had monochorionic placenta; higher number of twin 1 had Apgar score of ?7(p=0.004). Among twin who had inter-delivery interval of <30min; higher number of twin1 had Apgar score of ?7 at 5 minutes. (p=0.00). Second twin has lower Apgar score in relationship to period of gestation, mode of delivery, inter-delivery interval, and chorionicity.

A better understanding of the association between maternal perception of foetal movements and late stillbirth\u2014findings from an individual participant data meta-analysis

BackgroundLate stillbirth continues to affect 3–4/1000 pregnancies in high-resource settings, with even higher rates in low-resource settings. Reduced foetal movements are frequently reported by women prior to foetal death, but there remains a poor understanding of the reasons and how to deal with this symptom clinically, particularly during the preterm phase of gestation. We aimed to determine which women are at the greatest odds of stillbirth in relation to the maternal report of foetal movements in late pregnancy (≥ 28 weeks’ gestation).MethodsThis is an individual participant data meta-analysis of all identified case-control studies of late stillbirth. Studies included in the IPD were two from New Zealand, one from Australia, one from the UK and an internet-based study based out of the USA. There were a total of 851 late stillbirths, and 2257 controls with ongoing pregnancies.ResultsIncreasing strength of foetal movements was the most commonly reported (> 60%) pattern by women in late pregnancy, which were associated with a decreased odds of late stillbirth (adjusted odds ratio (aOR) = 0.20, 95% CI 0.15 to 0.27). Compared to no change in strength or frequency women reporting decreased frequency of movements in the last 2 weeks had increased odds of late stillbirth (aOR = 2.33, 95% CI 1.73 to 3.14). Interaction analysis showed increased strength of movements had a greater protective effect and decreased frequency of movements greater odds of late stillbirth at preterm gestations (28–36 weeks’ gestation). Foetal hiccups (aOR = 0.45, 95% CI 0.36 to 0.58) and regular episodes of vigorous movement (aOR = 0.67, 95% CI 0.52 to 0.87) were associated with decreased odds of late stillbirth. A single episode of unusually vigorous movement was associated with increased odds (aOR = 2.86, 95% CI 2.01 to 4.07), which was higher in women at term.ConclusionsReduced foetal movements are associated with late stillbirth, with the association strongest at preterm gestations. Foetal hiccups and multiple episodes of vigorous movements are reassuring at all gestations after 28 weeks’ gestation, whereas a single episode of vigorous movement is associated with stillbirth at term.

Neonatal Problems and Infancy Growth of Term SGA Infants: Does "SGA" Definition Need to Be Re-evaluated?

Introduction: The exact definition of small-for-gestational-age (SGA) infant is still controversial among clinicians. In this study, we aimed to understand which definition is better in terms of establishing both early postnatal problems and growth. In this way, we compared early neonatal problems and infancy growth of term infants with birth weight (BW) < -2 SDS and with BW between 10th percentile (−1.28 SDS) and −2 SDS.Methods: A single center retrospective cohort study was conducted. Preterm infants, multiple gestations and newborns with any congenital anomalies were excluded from the study. Study group was defined as Group 1 (n = 37), infants BW < −2.00 SDS; Group 2 (n = 129), between −1.28 and −2.00 SDS; and Group 3 (n = 137), randomly selected newborns with optimal-for-gestational-age (BW between −0.67 and +0.67 SDS) as a control group.Results: The incidence of severe hypoglycemia was highest in Group 1 (%10.8) and Group 2 and 3 had similar rates of severe hypoglycemia (0.8 and 0.7%, respectively). The incidence of polycythemia was 5.4% in Group 1 and was significantly higher than Group 3 (0.0%) while it was 2.3% in Group 2. Short stature (length < −2 SDS) ratio at the age of 1 and 2 years were similar in each group. Overweight/obesity ratio at the age of 1 were 9.5, 20.8 and 16.7% in each group, respectively (p = 0.509).Conclusion: This study was planned as a pilot study to determine potential differences in the problems of hypoglycemia, polycythemia, and growth according to the differences in definition. Short term disturbances such as hypoglycemia and polycythemia are found to be higher in infants with a BW SDS below −2. From this point of view, of course, it will not be possible to change the routine applications immediately, however this study will be an initiative for discussions by making long-term studies.

Hypertensive Disorders of Pregnancy.

Preeclampsia is a hypertensive disorder of pregnancy that is a leading cause of maternal and perinatal morbidity and mortality. The condition presents heterogeneously at varying gestational ages. Primary prevention for preeclampsia with low-dose aspirin is recommended for patients with clinical risk factors. Despite extensive research, there is no clearly defined pathophysiology for preeclampsia or treatment for preeclampsia besides delivery of the placenta. Delivery of patients with preeclampsia without severe features is indicated in the early term period at 37 weeks' gestation and sooner if the patient develops severe preeclampsia. Management of preterm preeclampsia is guided by close assessment of the status of the pregnant woman and fetus, blood pressure control, and surveillance for any clinical progression to a more severe form of preeclampsia that may require preterm delivery. In a preterm gestation affected by preeclampsia, expectant management is intended to provide neonatal benefit though it does assume some maternal risk. Future research will hopefully further delineate the pathophysiology of the condition with the ultimate goal of finding a treatment to avoid associated morbidity and preterm delivery.

Impact of fetal presentation on neurodevelopmental outcome in a trial of preterm vaginal delivery: a nationwide, population-based record linkage study

PurposeTo assess the risk of adverse neurodevelopmental outcomes at the age of four after an attempted vaginal delivery according to the fetal presentation in birth.MethodsThis retrospective record linkage study evaluated the risks of cerebral palsy, epilepsy, intellectual disability, autism spectrum disorder, attention-deficit/hyperactivity disorder, and speech, visual, and auditory disabilities among preterm children born after an attempted vaginal breech delivery. The control group comprised children born in a cephalic presentation at the same gestational age. This study included 23 803 singleton deliveries at gestational weeks 24 + 0–36 + 6 between 2004 and 2014.ResultsFrom 1629 women that underwent a trial of vaginal breech delivery, 1122 (66.3%) were converted to emergency cesarean sections. At extremely preterm and very preterm gestations (weeks 24 + 0—31 + 6), no association between a trial of vaginal breech delivery and neurodevelopmental delay occurred. At gestational weeks 32 + 0—36 + 6, the risks of visual disability (aOR 1.67, CI 1.07—2.60) and autism spectrum disorders (aOR 2.28, CI 1.14—4.56) were increased after an attempted vaginal breech delivery as compared to vaginal cephalic delivery.ConclusionA trial of vaginal breech delivery at extremely preterm and very preterm gestations appears not to increase the risk of adverse neurodevelopmental outcomes at the age of four. In moderate to late preterm births, a trial of vaginal breech delivery was associated with an increased risk of visual impairment and autism spectrum disorders compared to children born in cephalic presentation. A trial of vaginal preterm breech delivery requires distinctive consideration and careful patient selection.

Analysis of factors associated with the incidence of neonatal asphyxia in the neonatal intensive care unit (NICU) and perinatology unit in Wangaya Regional General Hospital

Background: Neonatal asphyxia is the second leading cause of neonatal death in Indonesia. According to the World Health Organization (WHO), neonatal asphyxia is the failure of neonates to begin and maintain normal breathing. Neonatal asphyxia can be caused by several factors, namely neonatal, maternal, placental, and delivery factors. This study is aimed to describe the factors associated with the incidence of neonatal asphyxia in Wangaya General Hospital.Methods: This study used an analytical method with a cross-sectional design. Data for the study were obtained from medical records. Study samples were selected using a simple random sampling technique, and the number of samples included was 170 neonates. The dependent variable was neonatal asphyxia, while the independent variables were preterm gestation, low birth weight baby, premature rupture of membrane, and delivery requiring the procedure. Data were analyzed with bivariate and multivariate analysis on SPSS.Results: The risk factors that showed association with neonatal asphyxia were preterm gestation (p=0.000; PR= 6.87; 95% CI: 3.19-14.79), low birth weight (p=0.000; PR=9.55; 95% CI 4.14-22.01), and premature rupture of membrane (p=0.002; PR=3.06; 95% CI: 1.48-6.3). while delivery requiring procedure was found to have no significant association with neonatal asphyxia (p=0.219, PR=0.64; 95% CI: 0.31-1.31). On multivariate analysis, it was found that preterm gestation, low birth weight, and premature rupture of membrane all showed significant association with neonatal asphyxia.Conclusion: There was a significant association between preterm gestation, low birth weight, and premature rupture of the membrane with neonatal asphyxia in Wangaya Regional General Hospital.

Association of antenatal corticosteroids with morbidity and mortality among preterm multiple gestations: meta-analysis of observational studies

ObjectiveThis meta-analysis aimed to assess the efficacy of antenatal corticosteroids (ACS) on morbidity and mortality among preterm multiple pregnancies.MethodsThe PubMed, Embase, Web of Science and Cochrane Library databases were searched...