RESUMO
OBJECTIVE: To assess the effect of antenatal magnesium sulfate exposure on neonatal demise. STUDY DESIGN: A retrospective analysis of prospectively captured data from 100 tertiary centers between May 1997 and January 2000 was performed. Included were nonanomalous newborns who were admitted to the neonatal intensive care unit between 23 and 34 completed weeks' gestation. Predictors of neonatal demise were determined from a pool of 24 candidate variables in a univariate analysis. A multivariate predictive model for mortality was constructed by using the variables that had significant interactions with the rate of demise (P < or = .1). RESULTS: A total of 12,876 cases were available for analysis. When these cases were stratified according to gestational age, magnesium was associated with a significant reduction in neonatal demise (OR, 0.67; 95% CI, 0.54 to 0.84; P =.0005). The effect remained when controlling for both gestational age and indication for therapy (adjusted OR, 0.70; 95% CI, 0.56 to 0.89; P =.003). The effect was similar in direction and magnitude in the final model after controlling for additional antenatal factors (OR, 0.82; 95% CI, 0.65 to 1.04; P =.108). CONCLUSION: Antenatal magnesium exposure is not associated with neonatal death, regardless of indication for therapy.
Assuntos
Idade Gestacional , Mortalidade Infantil , Sulfato de Magnésio/efeitos adversos , Resultado da Gravidez , Efeitos Tardios da Exposição Pré-Natal , Adulto , Intervalos de Confiança , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Exposição Materna/efeitos adversos , Razão de Chances , Gravidez , Cuidado Pré-Natal , Probabilidade , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Taxa de SobrevidaRESUMO
OBJECTIVE: Our purpose was to review the extended experience of a single maternal-fetal medicine practice with delayed-interval delivery. STUDY DESIGN: We completed a retrospective review of our maternal-fetal medicine practice database from January 1991 through March 1999. Patients were derived from both primary and consultative practices. All patients were managed with tocolysis, antibiotics, and cerclage after delivery of the first fetus(es). Retained siblings were investigated by amniocentesis to exclude intra-amniotic infection. RESULTS: Twenty-four consecutive patients had attempted delayed-interval delivery. Exclusion criteria for delayed-interval delivery included monochorionicity, abruptio placentae, severe preeclampsia, and the need for hysterotomy. The mean latency interval was 36 days, with a range of 3 to 123 days. Additionally, patients with previous cerclage(s) had significantly shorter mean latency intervals than patients without previous cerclage(s). Patients with long latency intervals (> or =49 days) had earlier births of the first fetus. CONCLUSION: Selected multichorionic pregnancies may benefit from delayed-interval delivery. Patients with previous cervical cerclage(s) during the index pregnancy are less likely to achieve significant latency intervals. Even modest intervals between births of siblings at critical gestational ages can improve neonatal survival and decrease neonatal morbidity.
Assuntos
Parto Obstétrico/métodos , Gravidez Múltipla , Colo do Útero/cirurgia , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Técnicas de Sutura , Fatores de Tempo , Trigêmeos , GêmeosRESUMO
The outcome of fetuses and newborn infants often is linked to maternal complications. IAI and PROM are key risk factors for neonatal sepsis.
