1. Planned delivery route and outcomes of cephalic singletons born spontaneously at 24‐31 weeks’ gestation: The EPIPAGE‐2 cohort study
- Author
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Elsa Lorthe, Adrien Gaudineau, François Goffinet, Bruno Langer, Isabelle Le Ray, Damien Subtil, Mathilde Quere, Department of Obstetrics and Gynecology, Les Hôpitaux Universitaires de Strasbourg (HUS), Hôpital Princesse Grace [Monaco], Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), ISPUP-EPIUnit [Porto, Portugal], Universidade do Porto, Maternité Port-Royal [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet [Stockholm], Pôle Femme Mère Nouveau-né, Hôpital Jeanne de Flandre [Lille], and Instituto de Saúde Pública da Universidade do Porto
- Subjects
Adult ,Male ,medicine.medical_specialty ,Population ,Gestational Age ,[SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,survival ,Patient Care Planning ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Obstetric Labor, Premature ,planned mode of delivery ,Pregnancy ,Infant Mortality ,medicine ,Very Preterm Birth ,Humans ,spontaneous preterm birth ,030212 general & internal medicine ,education ,education.field_of_study ,030219 obstetrics & reproductive medicine ,business.industry ,Vaginal delivery ,Obstetrics ,Cesarean Section ,Cephalic presentation ,Infant, Newborn ,Pregnancy Outcome ,Obstetrics and Gynecology ,Infant ,General Medicine ,EPIPAGE-2 ,medicine.disease ,Delivery, Obstetric ,Survival Analysis ,3. Good health ,Obstetric Labor Complications ,population-based study ,Gestation ,Female ,France ,business ,Premature rupture of membranes ,Infant, Premature ,Cohort study - Abstract
International audience; Introduction The objective of this study was to investigate the association between planned mode of delivery and neonatal outcomes with spontaneous very preterm birth among singletons in cephalic presentation. Material and methods Etude Epidemiologique sur les Petits Ages Gestationnels 2is a French national, prospective, population-based cohort study of preterm infants. For this study, we included women with a singleton cephalic pregnancy and spontaneous preterm labor or preterm premature rupture of membranes at 24-31 weeks' gestation. The main exposure was the planned mode of delivery (ie planned vaginal delivery or planned cesarean delivery at the initiation of labor). The primary outcome was survival at discharge and secondary outcome survival at discharge without severe morbidity. Propensity scores were used to minimize indication bias in estimating the association. Results The study population consisted of 1008 women: 206 (20.4%) had planned cesarean delivery and 802 (79.6%) planned vaginal delivery. In all, 723 (90.2%) finally had a vaginal delivery. Overall, 187 (92.0%) and 681 (87.0%) neonates in the planned cesarean delivery and planned vaginal delivery groups were discharged alive, and 156 (77.6%) and 590 (76.3%) were discharged alive without severe morbidity. After matching on propensity score, planned cesarean delivery was not associated with survival (adjusted odds ratio [aOR] 1.05, 95% confidence interval [CI] 0.48-2.28) or survival without severe morbidity (aOR 0.64, 95% CI 0.36-1.16). Conclusions Planned cesarean delivery for cephalic presentation at 24-31 weeks' gestation after preterm labor or preterm premature rupture of membranes does not improve neonatal outcomes.
- Published
- 2020