(903) Perinatal mortality and other severe outcomes following planned birth at 39 weeks versus expectant management.

Friday, January 31, 2025

10:30 AM – 12:30 PM

Coauthor(s)

KC

Kylie Crawford, PhD

Senior Epidemiologist
Mater Research Institute-The University of Queensland
Brisbane, Queensland, Australia
Waldemar A. Carlo, MD (he/him/his)

Professor
University of Alabama at Birmingham
Birmingham, Alabama, United States
Anthony O. Odibo, MD (he/him/his)

Professor
University of Missouri - Kansas City
Leawood, Kansas, United States
Aris T. Papageorghiou, FRCOG, MBBCH, MD

Professor of Fetal Medicine
University of Oxford
Oxford, England, United Kingdom
WT

William Tarnow-Mordi, MD

Professor
The University of Sydney
Sydney, New South Wales, Australia

Submitting Author and Presenting Author(s)

Sailesh Kumar, FRCOG, FRCS, MBBS, PhD (he/him/his)

Professor of Obstetrics & Gynaecology
The University of Queensland
Brisbane, Queensland, Australia

Objective: To investigate differences in perinatal and maternal outcomes in low-risk women following any type of planned birth (induction of labour or scheduled caesarean section) at 39⁺⁰ – 39⁺⁶ weeks versus expectant management.

Study Design: Retrospective cohort study. Study outcomes were perinatal mortality, severe neonatal neurological morbidity, severe neonatal non-neurological morbidity, severe maternal outcome, maternal-infant separation, severe perineal trauma, shoulder dystocia, and caesarean birth. Subgroup analyses according to parity and birthweight were also performed.

Results: Of 472,520 low-risk pregnancies >39⁺⁰ weeks planned birth at 39⁺⁰ – 39⁺⁶ weeks occurred in 97,438 (20.6%) women of whom 39,697 (40.7%) underwent induction of labour and 57,741 (59.3%) had scheduled caesarean delivery. Compared with expectant management, planned birth at 39⁺⁰ – 39⁺⁶ weeks was associated with lower odds of perinatal mortality (aOR 0.48; 95%CI 0.30, 0.76, p=0.002), antepartum stillbirth (aOR 0.38; 95%CI 0.15, 0.97, p=0.04), and intrapartum stillbirth (aOR 0.16; 95%CI 0.04, 0.66, p=0.01). Planned birth was also associated with reduction in the odds of severe neonatal neurological morbidity (aOR 0.46; 95%CI 0.39, 0.53, p=0.00004), severe neonatal non-neurological morbidity (aOR 0.65; 95%CI 0.62, 0.68, p=0.00004), severe maternal outcome (aOR 0.95; 95%CI 0.92,0.99, p=0.008) and increased odds of maternal-infant separation (aOR 1.04; 95%CI 1.00, 1.08, p=0.075). Planned birth by induction of labour was associated with reduced odds of caesarean delivery (aOR 0.54; 95%CI 0.51, 0.58, p=0.00004), severe perineal trauma (aOR 0.53; 95%CI 0.45, 0.63, p=0.00004), and shoulder dystocia (aOR 0.73; 95%CI 0.64, 0.84, p=0.00004).

Conclusion:

Planned birth between 39⁺⁰ – 39⁺⁶ weeks in low-risk women compared to expectant management was associated with lower odds of perinatal mortality, severe neonatal neurological and non-neurological morbidity and severe maternal outcome. For women who were induced, it was associated with lower odds of severe perineal trauma, shoulder dystocia, and caesarean birth.