HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Villar, J. Articles by Kramer, M. Search for Related Content PubMed PubMed Citation Articles by Villar, J. Articles by Kramer, M. Related Collections Preterm labor

Heterogeneity of Perinatal Outcomes in the Preterm Delivery Syndrome

From the United Nations Development Programme/United Nations Population Fund/World Health Organization/World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland; Centro Rosarino de Estudios Perinatales, Rosario, Argentina; Khon Kaen University, Khon Kaen, Thailand; Norwegian Institute of Public Health, Oslo, Norway; National Guard King Khalid Hospital, Jeddah, Saudi Arabia; Hospital Gineco-Obstétrico "América Arias," Havana, Cuba; Ministry of Health, Riyadh, Saudi Arabia; and Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada.

Address reprint requests to: Dr. José Villar, UNDP/UNFPA/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, 1211 Geneva 27, Switzerland; e-mail: villarj{at}who.int.

OBJECTIVE: Our aim was to document the differential neonatal morbidity and intrapartum and neonatal mortality of subgroups of preterm delivery.

METHODS: This analysis included 38,319 singleton pregnancies, of which 3,304 (8.6%) were preterm deliveries (less than 37 completed weeks) enrolled in the World Health Organization randomized trial of a new antenatal care model. We classified them as preterm deliveries after spontaneous initiation of labor, either with or without maternal obstetric and medical complications; preterm deliveries after prelabor spontaneous rupture of amniotic membranes (PROM), either with or without obstetric and medical complications; and medically indicated preterm deliveries with maternal obstetric and medical complications. Severe neonatal morbidity and neonatal mortality were the primary outcomes.

RESULTS: Fifty-six percent of all preterm deliveries were spontaneous, without maternal complications. Small for gestational age was increased only among the medically indicated preterm delivery group (22.3%). Very early preterm delivery (less than 32 weeks of gestation) was highest among PROM with complications (37%). For intrapartum fetal death and neonatal death, after adjusting by gestational age and other confounding variables, we found that the obstetric and medical complications preceding preterm delivery predicted the different risk levels. Conversely, for severe neonatal morbidity the clinical presentation, ie, PROM or medically indicated, predicted the increased risk.

CONCLUSION: There are differential neonatal outcomes among preterm deliveries according to clinical presentation, pregnancy complications, gestational age at delivery, and its association with small for gestational age. This syndromic nature of the condition should be considered if preterm delivery is to be fully understood and thus reduced.

LEVEL OF EVIDENCE: III

This article has been cited by other articles:

				J. M. Dodd, V. J. Flenady, R. Cincotta, and C. A. Crowther Progesterone for the Prevention of Preterm Birth: A Systematic Review Obstet. Gynecol., July 1, 2008; 112(1): 127 - 134. [Abstract] [Full Text] [PDF]

				C. K. Shapiro-Mendoza, K. M. Tomashek, M. Kotelchuck, W. Barfield, A. Nannini, J. Weiss, and E. Declercq Effect of Late-Preterm Birth and Maternal Medical Conditions on Newborn Morbidity Risk Pediatrics, February 1, 2008; 121(2): e223 - e232. [Abstract] [Full Text] [PDF]

				F. C. Barros and M. d. P. Velez Temporal trends of preterm birth subtypes and neonatal outcomes. Obstet. Gynecol., May 1, 2006; 107(5): 1035 - 1041. [Abstract] [Full Text] [PDF]

				G. P. Giacoia, D. L. Birenbaum, H. C. Sachs, and D. R. Mattison The newborn drug development initiative. Pediatrics, March 1, 2006; 117(3 Pt 2): S1 - S8. [Abstract] [Full Text] [PDF]

				D. Acolet, D. Elbourne, N. McIntosh, M. Weindling, M. Korkodilos, J. Haviland, J. Modder, M. Macintosh, and on behalf of the Confidential Enquiry Into Materna Project 27/28: Inquiry Into Quality of Neonatal Care and Its Effect on the Survival of Infants Who Were Born at 27 and 28 Weeks in England, Wales, and Northern Ireland Pediatrics, December 1, 2005; 116(6): 1457 - 1465. [Abstract] [Full Text] [PDF]

				K. S. Joseph and C. V. Ananth Re: "Preterm Delivery Rates in North Carolina: Are They Really Declining among Non-Hispanic African Americans?" Am. J. Epidemiol., June 15, 2005; 161(12): 1181 - 1181. [Full Text] [PDF]