ResearchObstetricsThe risk of fetal death: current concepts of best gestational age for delivery
Section snippets
Materials and Methods
This is a retrospective cohort analysis of the NCHS files on FD data and cohort-linked birth and infant death data for 2003-2005. Analyses were limited to singleton pregnancies delivered between 34 and 42 completed weeks' gestation. Multifetal gestations, fetal anomalies, and cases with missing or unknown variables for fetal anomalies or maternal medical conditions were excluded. In addition, cases with a birthweight inconsistent with the recorded GA were excluded according to the methods
Results
From 2003-2005, a total of 12,522,109 deliveries occurred in the United States, of which there were 12,360,994 live births and 161,115 FDs. Figure 1 depicts the number of deliveries that were excluded from this analysis because of the previously listed criteria. A total of 8,797,909 deliveries were used for our primary analysis with 8,785,132 (99.9%) live births and 12,777 (0.1%) FDs. These deliveries were further divided into HR and LR cohorts based on the presence or absence of preexisting
Comment
Using the NCHS data, we were able to examine the risk of FD and the NDR at each GA for a large cohort of singleton pregnancies in the United States. The analysis quantifies the fetal risk of being undelivered in the general population, and separately for HR and LR cohorts. The results demonstrate that the number of stillbirths occurring for patients who remain undelivered exceeds the number of neonatal deaths that would ensue from delivery of all subjects by 37-38 weeks' gestation. This finding
References (22)
- et al.
Are preterm births on the decline in the United States? Recent data from the National Vital Statistics System
NCHS data brief, no 39
(2010) - et al.
US birth weight/gestational age-specific neonatal mortality: 1995-1997 rates for whites, Hispanics, and blacks
Pediatrics
(2003) - et al.
Fetal and perinatal mortality, United States, 2005
Natl Vital Stat Rep
(2009) - et al.
The challenge of fetal mortality
NCHS Data Brief
(2009) - et al.
Are preterm births on the decline in the United States? Recent data from the National Vital Statistics System
NCHS Data Brief
(2010) - et al.
Differences in mortality between late-preterm and term singleton infants in the United States, 1995-2002
J Pediatr
(2007) - et al.
Timing of elective repeat cesarean delivery at term and neonatal outcomes
N Engl J Med
(2009) - et al.
Maternal and neonatal outcomes by labor onset type and gestational age
Am J Obstet Gynecol
(2010) - et al.
Reduction in elective delivery at <39 weeks of gestation: comparative effectiveness of 3 approaches to change and the impact on neonatal intensive care admission and stillbirth
Am J Obstet Gynecol
(2010) - et al.
Term pregnancy: a period of heterogeneous risk for infant mortality
Obstet Gynecol
(2011)
A statewide initiative to reduce inappropriate scheduled births at 360/7-386/7weeks' gestation
Am J Obstet Gynecol
Cited by (37)
The use of ultrasound, fibronectin and other parameters to predict the success of labour induction
2022, Best Practice and Research: Clinical Obstetrics and GynaecologyCitation Excerpt :The number of IOL is expected to increase with recent emerging evidence recommending IOL for a variety of medical indications [3]. IOL is also being considered for women of ≥35 years of age or even low-risk pregnancies, reaching 39 weeks’ gestation, as it has been shown that IOL is not associated with a significant impact on the rate of caesarean delivery when compared with expectant management [4,5] and may reduce the risk of intrauterine foetal death and hypertensive disorders of pregnancy [4,6]. IOL is undertaken when the benefits of delivery are considered to outweigh the risks of continuation of pregnancy.
The rising incidence and impact of non-medically indicated pre-labour cesarean section in Latin America
2019, Seminars in Fetal and Neonatal MedicineCitation Excerpt :Mandujano et al. performed a study trying to evaluate the optimal time of birth, that is, the one with the lowest risk of fetal and neonatal death. They evaluated low- and high-risk cohorts and found that the crossing point in which fetal deaths exceed neonatal deaths in high-risk pregnancies is close to 35–36 weeks, whereas in low-risk situations, that point is closer to week 38 [37]. We are probably facing a paradigm shift, which means a change in the way society organizes and interprets reality.
L. Marpeau in reply to the article by P. Rozenberg. To the question of elective induction of labor at 39 weeks of gestation, the answer lies in the question. Gynecol Obstet Fertil Senol;46:481–488
2018, Gynecologie Obstetrique Fertilite et SenologieTo the question of elective induction of labor at 39 weeks of gestation, the answer lies in the question
2018, Gynecologie Obstetrique Fertilite et SenologieMeasuring maternal, foetal and neonatal mortality: Challenges and solutions
2016, Best Practice and Research: Clinical Obstetrics and GynaecologyCitation Excerpt :This is a more accurate denominator for those at risk, and provides an estimate of the risk of foetal death at a given gestational age [27,28]. In high-income settings, this indicator has been used to compare the risk of foetal death with the neonatal mortality rate to determine the optimal gestational age for delivery [29]. Despite the existence of definitions and indicators, measuring mortality can be problematic.
US term stillbirth rates and the 39-week rule: A cause for concern?
2016, American Journal of Obstetrics and GynecologyCitation Excerpt :Considering that approximately 3,500,000 term births occur in the United States, that the estimated term stillbirth rate increase was 0.0186/1000 deliveries per year, and that the study period involved 6 yearly intervals, it would appear that approximately 335 more term stillbirths occurred in 2013 than in 2007. Because of the known link between increasing gestational age and increasing prospective risk of term stillbirth,17,18,37,38 a causative link between the progressive adoption of the 39-week rule and the progressive increase in the rate of term stillbirth is biologically plausible.20,39,40 The findings of this study are consistent with several small observational studies that each reported an increase in the rate of term stillbirth after the adoption of the Rule.32,33,36
The authors report no conflict of interest.
Reprints not available from the authors.
Cite this article as: Mandujano A, Waters TP, Myers SA. The risk of fetal death: current concepts of best gestational age for delivery. Am J Obstet Gynecol 2013;208:207.e1-8.