Obstetric determinants of neonatal survival: Influence of willingness to perform cesarean delivery on survival of extremely low-birth-weight infants

S. F. Bottoms, R. H. Paul, J. D. Iams, B. M. Mercer, E. A. Thom, J. M. Roberts, S. N. Caritis, A. H. Moawad, J. P. Van Dorsten, J. C. Hauth, G. R. Thurnau, M. Miodovnik, P. M. Meis, D. McNellis, C. MacPherson, G. S. Norman, P. Jones, E. Mueller-Heubach, M. Swain, R. L. GoldenbergR. L. Copper, R. Bain, E. Rowland, M. Lindheimer, M. K. Menard, B. A. Collins, S. Stramm, T. A. Siddiqi, N. Elder, J. C. Carey, A. Meuer, M. Fisher, S. J. Yaffe, C. Catz, M. Klebanoff, J. H. Harger, M. B. Landon, F. Johnson, B. W. Kovacs, Y. Rabello, B. M. Sibai, Risa Ramsey, M. P. Dombrowski, D. Lacey

Research output: Contribution to journalArticle

158 Citations (Scopus)

Abstract

OBJECTIVE: Our purpose was to evaluate the relationship between the approach to obstetric management and survival of extremely low-birth-weight infants. STUDY DESIGN: In this prospective observational study we evaluated 713 singleton births of infants weighing ≤1000 gm during 1 year at the 11 tertiary perinatal care centers of the National Institutes of Child Health and Human Development network of maternal-fetal medicine units. Major anomalies, extramural delivery, antepartum stillbirth, induced abortion, and gestational age <21 weeks were excluded. The obstetrician's opinion of viability and willingness to perform cesarean delivery in the event of fetal distress were ascertained from the medical record or interview when documentation was unclear. Grade 3 and 4 intraventricular hemorrhage, grade 3 and 4 retinopathy of prematurity, necrotizing enterocolitis requiring surgery, oxygen dependence at discharge or 120 days, and seizures were considered serious morbidity. Survival without serious morbidity was considered intact survival. Logistic regression was used to evaluate the influence of the approach to obstetric management, adjusted for birth weight, growth, gender, presentation, and ethnicity. RESULTS: Willingness to perform cesarean delivery was associated with increased likelihood of both survival (adjusted odds ratio 3.7, 95% confidence interval 2.3 to 6.0) and intact survival (adjusted odds ratio 1.8, 95% confidence interval 1.0 to 3.3). Willingness to intervene for fetal indications appeared to virtually eliminate intrapartum stillbirth and to reduce neonatal mortality. Below 800 gm or 26 weeks, however, willingness to perform cesarean delivery was linked to an increased chance of survival with serious morbidity. Although obstetricians were willing to intervene for fetal indications in most cases by 24 weeks, willingness to perform cesarean delivery was associated with twice the risk for serious morbidity at that gestational age. CONCLUSIONS: The approach to obstetric management significantly influences the outcome of extremely low-birth-weight infants. Above 800 gm or 26 weeks the obstetrician should usually be willing to perform cesarean delivery for fetal indications. Between 22 and 25 weeks willingness to intervene results in greater likelihood of both intact survival and survival with serious morbidity. In these cases patients and physicians should be aware of the impact of the approach to obstetric management and consider the likelihood of serious morbidity and mortality when formulating plans for delivery.

Original languageEnglish (US)
Pages (from-to)960-966
Number of pages7
JournalAmerican Journal of Obstetrics and Gynecology
Volume176
Issue number5
DOIs
StatePublished - Jan 1 1997

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Extremely Low Birth Weight Infant
Obstetrics
Survival
Morbidity
Stillbirth
Gestational Age
Odds Ratio
National Institute of Child Health and Human Development (U.S.)
Confidence Intervals
Perinatal Care
Fetal Distress
Retinopathy of Prematurity
Necrotizing Enterocolitis
Induced Abortion
Infant Mortality
Tertiary Care Centers
Birth Weight
Documentation
Medical Records
Observational Studies

All Science Journal Classification (ASJC) codes

  • Obstetrics and Gynecology

Cite this

Obstetric determinants of neonatal survival : Influence of willingness to perform cesarean delivery on survival of extremely low-birth-weight infants. / Bottoms, S. F.; Paul, R. H.; Iams, J. D.; Mercer, B. M.; Thom, E. A.; Roberts, J. M.; Caritis, S. N.; Moawad, A. H.; Van Dorsten, J. P.; Hauth, J. C.; Thurnau, G. R.; Miodovnik, M.; Meis, P. M.; McNellis, D.; MacPherson, C.; Norman, G. S.; Jones, P.; Mueller-Heubach, E.; Swain, M.; Goldenberg, R. L.; Copper, R. L.; Bain, R.; Rowland, E.; Lindheimer, M.; Menard, M. K.; Collins, B. A.; Stramm, S.; Siddiqi, T. A.; Elder, N.; Carey, J. C.; Meuer, A.; Fisher, M.; Yaffe, S. J.; Catz, C.; Klebanoff, M.; Harger, J. H.; Landon, M. B.; Johnson, F.; Kovacs, B. W.; Rabello, Y.; Sibai, B. M.; Ramsey, Risa; Dombrowski, M. P.; Lacey, D.

In: American Journal of Obstetrics and Gynecology, Vol. 176, No. 5, 01.01.1997, p. 960-966.

Research output: Contribution to journalArticle

Bottoms, SF, Paul, RH, Iams, JD, Mercer, BM, Thom, EA, Roberts, JM, Caritis, SN, Moawad, AH, Van Dorsten, JP, Hauth, JC, Thurnau, GR, Miodovnik, M, Meis, PM, McNellis, D, MacPherson, C, Norman, GS, Jones, P, Mueller-Heubach, E, Swain, M, Goldenberg, RL, Copper, RL, Bain, R, Rowland, E, Lindheimer, M, Menard, MK, Collins, BA, Stramm, S, Siddiqi, TA, Elder, N, Carey, JC, Meuer, A, Fisher, M, Yaffe, SJ, Catz, C, Klebanoff, M, Harger, JH, Landon, MB, Johnson, F, Kovacs, BW, Rabello, Y, Sibai, BM, Ramsey, R, Dombrowski, MP & Lacey, D 1997, 'Obstetric determinants of neonatal survival: Influence of willingness to perform cesarean delivery on survival of extremely low-birth-weight infants', American Journal of Obstetrics and Gynecology, vol. 176, no. 5, pp. 960-966. https://doi.org/10.1016/S0002-9378(97)70386-7
Bottoms, S. F. ; Paul, R. H. ; Iams, J. D. ; Mercer, B. M. ; Thom, E. A. ; Roberts, J. M. ; Caritis, S. N. ; Moawad, A. H. ; Van Dorsten, J. P. ; Hauth, J. C. ; Thurnau, G. R. ; Miodovnik, M. ; Meis, P. M. ; McNellis, D. ; MacPherson, C. ; Norman, G. S. ; Jones, P. ; Mueller-Heubach, E. ; Swain, M. ; Goldenberg, R. L. ; Copper, R. L. ; Bain, R. ; Rowland, E. ; Lindheimer, M. ; Menard, M. K. ; Collins, B. A. ; Stramm, S. ; Siddiqi, T. A. ; Elder, N. ; Carey, J. C. ; Meuer, A. ; Fisher, M. ; Yaffe, S. J. ; Catz, C. ; Klebanoff, M. ; Harger, J. H. ; Landon, M. B. ; Johnson, F. ; Kovacs, B. W. ; Rabello, Y. ; Sibai, B. M. ; Ramsey, Risa ; Dombrowski, M. P. ; Lacey, D. / Obstetric determinants of neonatal survival : Influence of willingness to perform cesarean delivery on survival of extremely low-birth-weight infants. In: American Journal of Obstetrics and Gynecology. 1997 ; Vol. 176, No. 5. pp. 960-966.
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abstract = "OBJECTIVE: Our purpose was to evaluate the relationship between the approach to obstetric management and survival of extremely low-birth-weight infants. STUDY DESIGN: In this prospective observational study we evaluated 713 singleton births of infants weighing ≤1000 gm during 1 year at the 11 tertiary perinatal care centers of the National Institutes of Child Health and Human Development network of maternal-fetal medicine units. Major anomalies, extramural delivery, antepartum stillbirth, induced abortion, and gestational age <21 weeks were excluded. The obstetrician's opinion of viability and willingness to perform cesarean delivery in the event of fetal distress were ascertained from the medical record or interview when documentation was unclear. Grade 3 and 4 intraventricular hemorrhage, grade 3 and 4 retinopathy of prematurity, necrotizing enterocolitis requiring surgery, oxygen dependence at discharge or 120 days, and seizures were considered serious morbidity. Survival without serious morbidity was considered intact survival. Logistic regression was used to evaluate the influence of the approach to obstetric management, adjusted for birth weight, growth, gender, presentation, and ethnicity. RESULTS: Willingness to perform cesarean delivery was associated with increased likelihood of both survival (adjusted odds ratio 3.7, 95{\%} confidence interval 2.3 to 6.0) and intact survival (adjusted odds ratio 1.8, 95{\%} confidence interval 1.0 to 3.3). Willingness to intervene for fetal indications appeared to virtually eliminate intrapartum stillbirth and to reduce neonatal mortality. Below 800 gm or 26 weeks, however, willingness to perform cesarean delivery was linked to an increased chance of survival with serious morbidity. Although obstetricians were willing to intervene for fetal indications in most cases by 24 weeks, willingness to perform cesarean delivery was associated with twice the risk for serious morbidity at that gestational age. CONCLUSIONS: The approach to obstetric management significantly influences the outcome of extremely low-birth-weight infants. Above 800 gm or 26 weeks the obstetrician should usually be willing to perform cesarean delivery for fetal indications. Between 22 and 25 weeks willingness to intervene results in greater likelihood of both intact survival and survival with serious morbidity. In these cases patients and physicians should be aware of the impact of the approach to obstetric management and consider the likelihood of serious morbidity and mortality when formulating plans for delivery.",
author = "Bottoms, {S. F.} and Paul, {R. H.} and Iams, {J. D.} and Mercer, {B. M.} and Thom, {E. A.} and Roberts, {J. M.} and Caritis, {S. N.} and Moawad, {A. H.} and {Van Dorsten}, {J. P.} and Hauth, {J. C.} and Thurnau, {G. R.} and M. Miodovnik and Meis, {P. M.} and D. McNellis and C. MacPherson and Norman, {G. S.} and P. Jones and E. Mueller-Heubach and M. Swain and Goldenberg, {R. L.} and Copper, {R. L.} and R. Bain and E. Rowland and M. Lindheimer and Menard, {M. K.} and Collins, {B. A.} and S. Stramm and Siddiqi, {T. A.} and N. Elder and Carey, {J. C.} and A. Meuer and M. Fisher and Yaffe, {S. J.} and C. Catz and M. Klebanoff and Harger, {J. H.} and Landon, {M. B.} and F. Johnson and Kovacs, {B. W.} and Y. Rabello and Sibai, {B. M.} and Risa Ramsey and Dombrowski, {M. P.} and D. Lacey",
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TY - JOUR

T1 - Obstetric determinants of neonatal survival

T2 - Influence of willingness to perform cesarean delivery on survival of extremely low-birth-weight infants

AU - Bottoms, S. F.

AU - Paul, R. H.

AU - Iams, J. D.

AU - Mercer, B. M.

AU - Thom, E. A.

AU - Roberts, J. M.

AU - Caritis, S. N.

AU - Moawad, A. H.

AU - Van Dorsten, J. P.

AU - Hauth, J. C.

AU - Thurnau, G. R.

AU - Miodovnik, M.

AU - Meis, P. M.

AU - McNellis, D.

AU - MacPherson, C.

AU - Norman, G. S.

AU - Jones, P.

AU - Mueller-Heubach, E.

AU - Swain, M.

AU - Goldenberg, R. L.

AU - Copper, R. L.

AU - Bain, R.

AU - Rowland, E.

AU - Lindheimer, M.

AU - Menard, M. K.

AU - Collins, B. A.

AU - Stramm, S.

AU - Siddiqi, T. A.

AU - Elder, N.

AU - Carey, J. C.

AU - Meuer, A.

AU - Fisher, M.

AU - Yaffe, S. J.

AU - Catz, C.

AU - Klebanoff, M.

AU - Harger, J. H.

AU - Landon, M. B.

AU - Johnson, F.

AU - Kovacs, B. W.

AU - Rabello, Y.

AU - Sibai, B. M.

AU - Ramsey, Risa

AU - Dombrowski, M. P.

AU - Lacey, D.

PY - 1997/1/1

Y1 - 1997/1/1

N2 - OBJECTIVE: Our purpose was to evaluate the relationship between the approach to obstetric management and survival of extremely low-birth-weight infants. STUDY DESIGN: In this prospective observational study we evaluated 713 singleton births of infants weighing ≤1000 gm during 1 year at the 11 tertiary perinatal care centers of the National Institutes of Child Health and Human Development network of maternal-fetal medicine units. Major anomalies, extramural delivery, antepartum stillbirth, induced abortion, and gestational age <21 weeks were excluded. The obstetrician's opinion of viability and willingness to perform cesarean delivery in the event of fetal distress were ascertained from the medical record or interview when documentation was unclear. Grade 3 and 4 intraventricular hemorrhage, grade 3 and 4 retinopathy of prematurity, necrotizing enterocolitis requiring surgery, oxygen dependence at discharge or 120 days, and seizures were considered serious morbidity. Survival without serious morbidity was considered intact survival. Logistic regression was used to evaluate the influence of the approach to obstetric management, adjusted for birth weight, growth, gender, presentation, and ethnicity. RESULTS: Willingness to perform cesarean delivery was associated with increased likelihood of both survival (adjusted odds ratio 3.7, 95% confidence interval 2.3 to 6.0) and intact survival (adjusted odds ratio 1.8, 95% confidence interval 1.0 to 3.3). Willingness to intervene for fetal indications appeared to virtually eliminate intrapartum stillbirth and to reduce neonatal mortality. Below 800 gm or 26 weeks, however, willingness to perform cesarean delivery was linked to an increased chance of survival with serious morbidity. Although obstetricians were willing to intervene for fetal indications in most cases by 24 weeks, willingness to perform cesarean delivery was associated with twice the risk for serious morbidity at that gestational age. CONCLUSIONS: The approach to obstetric management significantly influences the outcome of extremely low-birth-weight infants. Above 800 gm or 26 weeks the obstetrician should usually be willing to perform cesarean delivery for fetal indications. Between 22 and 25 weeks willingness to intervene results in greater likelihood of both intact survival and survival with serious morbidity. In these cases patients and physicians should be aware of the impact of the approach to obstetric management and consider the likelihood of serious morbidity and mortality when formulating plans for delivery.

AB - OBJECTIVE: Our purpose was to evaluate the relationship between the approach to obstetric management and survival of extremely low-birth-weight infants. STUDY DESIGN: In this prospective observational study we evaluated 713 singleton births of infants weighing ≤1000 gm during 1 year at the 11 tertiary perinatal care centers of the National Institutes of Child Health and Human Development network of maternal-fetal medicine units. Major anomalies, extramural delivery, antepartum stillbirth, induced abortion, and gestational age <21 weeks were excluded. The obstetrician's opinion of viability and willingness to perform cesarean delivery in the event of fetal distress were ascertained from the medical record or interview when documentation was unclear. Grade 3 and 4 intraventricular hemorrhage, grade 3 and 4 retinopathy of prematurity, necrotizing enterocolitis requiring surgery, oxygen dependence at discharge or 120 days, and seizures were considered serious morbidity. Survival without serious morbidity was considered intact survival. Logistic regression was used to evaluate the influence of the approach to obstetric management, adjusted for birth weight, growth, gender, presentation, and ethnicity. RESULTS: Willingness to perform cesarean delivery was associated with increased likelihood of both survival (adjusted odds ratio 3.7, 95% confidence interval 2.3 to 6.0) and intact survival (adjusted odds ratio 1.8, 95% confidence interval 1.0 to 3.3). Willingness to intervene for fetal indications appeared to virtually eliminate intrapartum stillbirth and to reduce neonatal mortality. Below 800 gm or 26 weeks, however, willingness to perform cesarean delivery was linked to an increased chance of survival with serious morbidity. Although obstetricians were willing to intervene for fetal indications in most cases by 24 weeks, willingness to perform cesarean delivery was associated with twice the risk for serious morbidity at that gestational age. CONCLUSIONS: The approach to obstetric management significantly influences the outcome of extremely low-birth-weight infants. Above 800 gm or 26 weeks the obstetrician should usually be willing to perform cesarean delivery for fetal indications. Between 22 and 25 weeks willingness to intervene results in greater likelihood of both intact survival and survival with serious morbidity. In these cases patients and physicians should be aware of the impact of the approach to obstetric management and consider the likelihood of serious morbidity and mortality when formulating plans for delivery.

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