Is 34 Weeks an Acceptable Goal For a Complicated Singleton Pregnancy?
MANAGED CARE October 2002. ©MediMedia USA
This paper has undergone peer review by appropriate members of Managed Care's Editorial Advisory Board.
Purpose: To examine neonatal risk and associated nursery costs for infants with delivery following untreated preterm labor at 34, 35, or 36 weeks' gestation, by assessing the incidence of neonatal intensive care unit (NICU) admission, respiratory distress syndrome (RDS), and need for ventilatory assistance.
Design: Infants with preterm birth at 34, 35, or 36 weeks were identified from a database of prospectively collected clinical information and pregnancy outcomes of women receiving outpatient preterm-labor management services, in addition to routine prenatal care. Cases of singleton gestations with delivery related to spontaneous preterm labor were analyzed. Data were divided into three groups by gestational week at delivery.
Methodology: Descriptive and statistical methods were used to compare maternal demographics, pregnancy outcome, and nursery costs. A cost model was utilized.
Principal findings: 2849 infants were studied. Risk of NICU admission decreased by 47.4 percent from weeks 34 to 35 and 41.8 percent from weeks 35 to 36. Risk of RDS decreased by 25.4 percent from weeks 34 to 35, and 40.7 percent from weeks 35 to 36. Mean nursery costs per infant delivering at 34, 35, and 36 weeks were $11,439 ± $19,774, $5,796 ± $11,858, and $3,824 ± $9,135, respectively (p<.001).
Conclusion: Rates of NICU admission, RDS, ventilator use, and nursery-related costs decreased significantly with each week gained. The data indicate that benefit is derived in prolonging pregnancy beyond 34 weeks.
Key words: preterm delivery; preterm labor; prematurity; neonatal morbidity; respiratory-distress syndrome; cost effectiveness; outcomes
J. Stephen Jones, MD
Director, McLeod Maternal-Fetal Medicine
McLeod Medical Park-East
901 E. Cheves St., Ste. 430
Florence, SC 29506
This study was undertaken without external financial support for the participating authors and institutions.