TY - JOUR
T1 - The mortality risk of expectant management compared with delivery stratified by gestational age and race and ethnicity
AU - Rosenstein, Melissa G.
AU - Snowden, Jonathan M.
AU - Cheng, Yvonne W.
AU - Caughey, Aaron B.
N1 - Publisher Copyright:
© 2014 Elsevier Inc. All rights reserved.
PY - 2014/12/1
Y1 - 2014/12/1
N2 - 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.
AB - 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.
KW - expectant management
KW - mortality risk
KW - race/ethnicity
KW - stillbirth
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U2 - 10.1016/j.ajog.2014.06.008
DO - 10.1016/j.ajog.2014.06.008
M3 - Article
C2 - 24909340
AN - SCOPUS:84922991724
SN - 0002-9378
VL - 211
SP - 660.e1-660.e8
JO - American journal of obstetrics and gynecology
JF - American journal of obstetrics and gynecology
IS - 6
ER -