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Epicure 2: obstetric antecedents of extremely premature delivery in England
  1. AS Morgan1,
  2. N Marlow1,
  3. ES Draper2,
  4. KL Costeloe3
  1. 1Institute for Women's Health, University College London, London, UK
  2. 2Department of Health Sciences, University of Leicester, Leicester, UK
  3. 3Department of Neonatology, Queen Mary, University of London, London, UK

Abstract

Objectives To examine the effects of antenatal steroids, tocolysis, and delivery mode on extremely preterm delivery; to identify other potential antecedents through a hypothesis-generating analysis.

Design National cohort study.

Setting England.

Participants Singleton pregnancies delivering before 27 weeks gestation during 2006.

Main outcome measures Survival at birth (heart rate > 100 at 5 minutes) and at hospital discharge.

Results 1723 births were identified for inclusion. Antenatal steroids were associated with improvements in live birth (adjusted odds ratio (aOR) for any steroids: 1.65, 95% CI: 1.20–2.27) and survival to discharge (partial course of steroids: aOR 1.80, (1.25–2.59); complete course: aOR 2.38, (1.69–3.34)). Tocolysis was positively associated with both: aORs 1.38 (1.04-1.83) and 1.32 (1.04-1.68) for survival at birth and discharge, respectively. Caesarean delivery did not affect either outcome after adjustment.

In the hypothesis-generating analysis, gestational age had the strongest influence (aORs per week: 2.08 (1.86–2.34) for live birth; aOR 2.89 (2.56–3.28) for survival to discharge). Male sex reduced survival to discharge (aOR 0.64 (0.50–0.82)), as did non-cephalic presentation (aOR 0.59 (0.46–0.75)), in contrast with an aOR of 1.99 (1.17–3.43) for cervical cerclage and of 1.76 (1.27–2.45) for a spontaneous onset of labour.

Discussion Our results confirm the efficacy of antenatal steroids and tocolysis for promoting survival of extremely premature babies. Fetal sex, presentation, presence of a cervical suture, and a spontaneous onset of labour potentially provide extra information concerning the odds of survival over and above gestational age; these factors warrant further investigation and may influence management decisions and counselling.

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