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Cited by 330Preterm Birth and ChorioamnionitisInfant Development and Preterm CareMaternal and Perinatal Health Interventions

Maternal-fetal conditions necessitating a medical intervention resulting in preterm birth

Ananth, Cande V., Vintzileos, Anthony M.·2006·American Journal of Obstetrics and Gynecology
DOI 10.1016/j.ajog.2006.05.021
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Abstract

Objective The objective of the study was to evaluate the extent to which maternal and fetal conditions necessitate medically indicated preterm birth.Study design A population-based, retrospective, cohort study of women who delivered a singleton live birth at 20 weeks or longer in Missouri, 1989 to 1997 was performed (n = 684,711). Maternal-fetal conditions that necessitated iatrogenic preterm birth included preeclampsia, small-for-gestational-age birth, fetal distress, placental abruption, placenta previa, unexplained vaginal bleeding, pregestational and gestational diabetes, renal disease, Rh sensitization, and congenital malformations. We examined the association between each of the aforementioned conditions and risk of medically indicated preterm birth at less than 35 weeks. Medically indicated preterm birth was defined as a labor induction or a prelabor cesarean in the absence of premature rupture of membranes at preterm gestations. Adjusted relative risk with 95% confidence interval for preterm birth was derived from multivariable logistic regression models, and population attributable fractions were calculated.Results The preterm birth rate (less than 35 weeks) was 4.6% (n = 31,238), with 23.5% (n = 7,347) of such births being medically indicated. Preeclampsia, fetal distress, small-for-gestational-age, and placental abruption were the most common indications for a medical intervention resulting in preterm birth, with at least 1 of these conditions present in 53.2% of medically indicated preterm births and in 17.7% of term births (relative risk 4.9, 95% confidence interval 4.7, 5.2).Conclusion Preeclampsia, fetal distress, small-for-gestational-age, and placental abruption, conditions that are associated with ischemic placental disease, are implicated in well over half of all medically indicated preterm births. Although the etiology of preterm birth is heterogeneous, it is reasonable that ischemic placental disease may serve as an important pathway to preterm birth.

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  • Chronic changes predispose to abruption as well as other placentally mediated pathologies, including fetal growth restriction and preeclampsia.

    “These chronic changes predispose to abruption as well as other placentally mediated pathologies, including fetal growth restriction (FGR) and preeclampsia (12), often occurring weeks or months before the manifestations of these complications become clinically evident (8).”

    From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [12]

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Authors
Ananth, C. V., & Vintzileos, A. M.
Affiliations
University of Medicine and Dentistry of New Jersey (US)
Corresponding author
Ananth, Cande V.
ORCID
Venue
American Journal of Obstetrics and Gynecology
Publisher
Elsevier BV
Published
2006-12
Volume
195
Issue
6
Pages
1557-1563
ISSN
0002-9378 (ISSN-L)
DOI
10.1016/j.ajog.2006.05.021
OpenAlex
W2014584719
Cited by
330
References
31
Citations by year
2026: 17 · 2025: 13 · 2024: 12 · 2023: 15 · 2022: 13 · 2021: 22 · 2020: 18 · 2019: 17 · 2018: 25 · 2017: 23 · 2016: 15 · 2015: 22 · 2014: 25 · 2013: 10 · 2012: 18
FWCI
9.27
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • American Journal of Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
Funders
Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD038902)
Topics
  • Health Sciences › Medicine › Epidemiology › Preterm Birth and Chorioamnionitis
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
Keywords
medically indicated preterm birth, preeclampsia, fetal distress, small for gestational age, placental abruption, ischemic placental disease, labor induction, preterm birth risk factors, congenital malformations, Rh isoimmunization, gestational diabetes mellitus, placenta previa
MeSH terms
Abruptio Placentae, Adult, Cesarean Section, Female, Fetal Diseases, Fetal Distress, Humans, Infant, Newborn, Infant, Small for Gestational Age, Ischemia, Labor, Induced, Placenta, Pre-Eclampsia, Pregnancy, Pregnancy Complications, Retrospective Studies, Risk, Cohort Studies, Incidence, Premature Birth

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