by lemons (75 Posts), Fri May 25, 2012 11:22 am
I have read the full text of the research article in question (Ehrenthal, et al. Neonatal Outcomes After Implementation of Guidelines Limiting Elective Delivery Before 39 Weeks of Gestation. Obstet Gynecol 118(5):1047–1055)
To provide some answers:
1. The "intervention" for the study was to educate OBs and MFMs about the American College of Obstetricians and Gynecologists recommendations to limit early term (37-38 completed weeks gestation) elective deliveries. These recommendations allow for delivery in cases of either maternal or fetal indications, including: PIH, preeclampsia, HELLP, gestational diabetes, and many others.
2. The data did NOT exclude pregnancies that were complicated by these maternal or fetal indications. Instead, the data include ALL births that completed 37 weeks gestation.
3. Of the 7 stillbirths at tern (37+ weeks) that were recorded PRIOR to the intervention- 4 were due to cord accidents (one was a two vessel cord), 1 was due to placental insufficiency, and 2 were unexplained. Of the stillbirths due to cord accident, there were no maternal risk factors identified. The stillbirth due to placental insufficiency was in a postdated pregnancy (41 completed weeks gestation). One of the unexplained stillbirths was in a mother with the risk factor of "advanced maternal age" (greater than 35). Point being that none of the stillbirths were to mothers with indications of PIH, preeclampsia, or other hypertensive related conditions.
4. Of the 15 stillbirths (which excludes 2 stillbirths related to chromosomal or congenital abnormality) at term (37+ weeks) recorded AFTER the intervention- one was unexplained with a maternal risk factor of gestational diabetes, one was unexplained with a maternal risk factor of chronic hypertension, one was unexplained with a risk factor of prepregnancy diabetes, one was due to IUGR presumably from cocaine exposure, one was due to fetal infection after the in utero repair of a congenital heart defect. All of these 5 pregnancies should have been considered high risk and should have been candidates for early delivery according to the ACOG recommendations. I am not going to provide the rest of the results unless one of you really wants....
And now for my own take on the results-
The take home that I concluded and was subsequently pointed out in comments on the original article, is that apparently, the recommendations from the ACOG were not being effectively implemented. I think that maybe before the intervention (push to limit early term deliveries), physicians were delivering ANYONE who might have a slight indication for delivery, as evidenced by the lack of maternal risk factors for most pre-intervention stillbirths. And then after the intervention, patients with indications warranting elective delivery were being missed.
Overall, I think this study is a great indication of why the Preeclampsia Foundation has such an important role to play in safe guarding the health of both pregnant women and their babies- education, education, education, of care providers, pregnant women, and their partners/families. Hopefully, this has helped. I am happy to answer more questions regarding the actual study. But due to copyright restrictions, I can not distribute the actual article.
Diana, happily married since 2007.
Miscarriage at 10 weeks (June 2009).
DD at 30+0 weeks weighing 2lbs 9oz (October 2010) due to PE and IUGR. Today, a happy and healthy toddler.