Obstetric interventions for babies born before 28 weeks of gestation in Europe: results of the MOSAIC study

Autor: L A A, Kollée, M, Cuttini, D, Delmas, E, Papiernik, A L, den Ouden, R, Agostino, K, Boerch, G, Bréart, J-L, Chabernaud, E S, Draper, L, Gortner, W, Künzel, R F, Maier, J, Mazela, D, Milligan, P, Van Reempts, T, Weber, J, Zeitlin, L, Kollée
Rok vydání: 2009
Předmět:
Zdroj: BJOG : an International Journal of Obstetrics and Gynaecology, 116, 1481-91
BJOG : an International Journal of Obstetrics and Gynaecology, 116, 11, pp. 1481-91
ISSN: 1470-0328
Popis: Contains fulltext : 81447.pdf (Publisher’s version ) (Closed access) OBJECTIVE: To describe obstetric intervention for extremely preterm births in ten European regions and assess its impact on mortality and short term morbidity. DESIGN: Prospective observational cohort study. SETTING: Ten regions from nine countries participating in the 'Models of Organising Access to Intensive Care for Very Preterm Babies in Europe' (MOSAIC) project. POPULATION: All births from 22 to 29 weeks of gestation (n = 4146) in 2003, excluding terminations of pregnancy. METHODS: Comparison of three obstetric interventions (antenatal corticosteroids, antenatal transfer and caesarean section for fetal indication) rates at 22-23, 24-25 and 26-27 weeks to that at 28-29 weeks and the association of the level of intervention with pregnancy outcome. MAIN OUTCOME MEASURES: Use of antenatal corticosteroids, antenatal transfer and caesarean section by two-week gestational age groups as well as a composite score of these three interventions. Outcomes included stillbirth, in-hospital mortality and intraventricular haemorrhage (IVH) grades III and IV and/or periventricular leucomalacia (PVL) and bronchopulmonary dysplasia (BPD). RESULTS: There were large differences between regions in interventions for births at 22-23 and 24-25 weeks. Differences were most pronounced at 24-25 weeks; in some regions these babies received the same care as babies of 28-29 weeks, whereas elsewhere levels of intervention were distinctly lower. Before 26 weeks and especially at 24-25 weeks, there was an association between the composite intervention score and mortality. No association was observed at 26-27 weeks. For survivors at 24-25 weeks, the intervention score was associated with higher rates of BPD, but not with IVH or PVL. CONCLUSIONS: There are large differences between European regions in obstetric practices at the lower limit of viability and these are related to outcome, especially at 24-25 weeks.
Databáze: OpenAIRE
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