The mortality risk of expectant management compared with delivery stratified by gestational age and race and ethnicity

Melissa G. Rosenstein, Jonathan Snowden, Yvonne W. Cheng, Aaron Caughey

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

OBJECTIVE: The objective of the study was to compare the mortality risk of expectant management with the risk of delivery at each week of term pregnancy in 4 racial/ethnic groups.

STUDY DESIGN: This was a retrospective cohort study of all nonanomalous, term deliveries in California from 1997 to 2006 among white, black, Hispanic, and Asian women. In each racial/ethnic group, we compared the risk of infant death at each week with a composite risk representing the mortality risk of 1 week of expectant management.

RESULTS: The risk of stillbirth and infant death is highest in black women (stillbirth risk: 18.0 per 10,000, infant death: 24.4 per 10,000, compared with 9.4 per 10,000 and 10.8 per 10,000 in white women, respectively; P <.001). Although absolute risks differ by race/ethnicity, the composite risk of expectant management does not surpass the risk of delivery until 39 weeks in any group. At 39 weeks these absolute risk differences are low, however, with a number needed to deliver to prevent 1 death ranging from 751 (among black women) to 2587 (among Asian women).

CONCLUSION: The mortality risk of expectant management exceeds the risk of delivery at 39 weeks in all racial/ethnic groups, despite variation in absolute risks.

Original languageEnglish (US)
JournalAmerican Journal of Obstetrics and Gynecology
Volume211
Issue number6
DOIs
StatePublished - Dec 1 2014

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Risk Management
Gestational Age
Mortality
Ethnic Groups
Stillbirth
Hispanic Americans
Cohort Studies
Retrospective Studies
Pregnancy

Keywords

  • expectant management
  • mortality risk
  • race/ethnicity
  • stillbirth

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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abstract = "OBJECTIVE: The objective of the study was to compare the mortality risk of expectant management with the risk of delivery at each week of term pregnancy in 4 racial/ethnic groups.STUDY DESIGN: This was a retrospective cohort study of all nonanomalous, term deliveries in California from 1997 to 2006 among white, black, Hispanic, and Asian women. In each racial/ethnic group, we compared the risk of infant death at each week with a composite risk representing the mortality risk of 1 week of expectant management.RESULTS: The risk of stillbirth and infant death is highest in black women (stillbirth risk: 18.0 per 10,000, infant death: 24.4 per 10,000, compared with 9.4 per 10,000 and 10.8 per 10,000 in white women, respectively; P <.001). Although absolute risks differ by race/ethnicity, the composite risk of expectant management does not surpass the risk of delivery until 39 weeks in any group. At 39 weeks these absolute risk differences are low, however, with a number needed to deliver to prevent 1 death ranging from 751 (among black women) to 2587 (among Asian women).CONCLUSION: The mortality risk of expectant management exceeds the risk of delivery at 39 weeks in all racial/ethnic groups, despite variation in absolute risks.",
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