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BJOG. 2009 Oct;116(11):1481-91. doi: 10.1111/j.1471-0528.2009.02235.x. Epub 2009 Jul 7.

Obstetric interventions for babies born before 28 weeks of gestation in Europe: results of the MOSAIC study.

Author information

1
Department of Paediatrics, Children's Hospital, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. l.kollee@cukz.umcn.nl

Abstract

OBJECTIVE:

To describe obstetric intervention for extremely preterm births in ten European regions and assess its impact on mortality and short term morbidity.

DESIGN:

Prospective observational cohort study.

SETTING:

Ten regions from nine countries participating in the 'Models of Organising Access to Intensive Care for Very Preterm Babies in Europe' (MOSAIC) project.

POPULATION:

All births from 22 to 29 weeks of gestation (n = 4146) in 2003, excluding terminations of pregnancy.

METHODS:

Comparison of three obstetric interventions (antenatal corticosteroids, antenatal transfer and caesarean section for fetal indication) rates at 22-23, 24-25 and 26-27 weeks to that at 28-29 weeks and the association of the level of intervention with pregnancy outcome.

MAIN OUTCOME MEASURES:

Use of antenatal corticosteroids, antenatal transfer and caesarean section by two-week gestational age groups as well as a composite score of these three interventions. Outcomes included stillbirth, in-hospital mortality and intraventricular haemorrhage (IVH) grades III and IV and/or periventricular leucomalacia (PVL) and bronchopulmonary dysplasia (BPD).

RESULTS:

There were large differences between regions in interventions for births at 22-23 and 24-25 weeks. Differences were most pronounced at 24-25 weeks; in some regions these babies received the same care as babies of 28-29 weeks, whereas elsewhere levels of intervention were distinctly lower. Before 26 weeks and especially at 24-25 weeks, there was an association between the composite intervention score and mortality. No association was observed at 26-27 weeks. For survivors at 24-25 weeks, the intervention score was associated with higher rates of BPD, but not with IVH or PVL.

CONCLUSIONS:

There are large differences between European regions in obstetric practices at the lower limit of viability and these are related to outcome, especially at 24-25 weeks.

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