How often are late preterm births the result of non‐evidence based practices: analysis from a retrospective cohort study at two tertiary referral centres in a nationalised healthcare system

Abstract

Objective To determine the proportion, characteristics, and predictors of late preterm birth (LPTB) in relation to evidence-based (EB) and non-evidence based (NEB) indications.Design Retrospective cohort study.Setting Two Canadian tertiary referral centres.Population All live singleton LPTBs over 1 year from 2010 to 2011, excluding major congenital anomalies.Methods Indications for LPTB were classified a priori as EB (i.e. based on practice guidelines or on evidence from randomised controlled trials) or NEB. Data were abstracted from maternal antenatal and labour records. Univariate analyses were completed using Fischer's exact, Pearson's chi-square, or analysis of variance (ANOVA) F-tests. Logistic regression included gestation at birth, delivery provider, previous stillbirth, previous caesarean section, corticosteroid administration, and previous preterm birth as predictors for NEB LPTB.Main outcome measures The proportion, characteristics, and predictors of women with NEB versus EB LPTBs.Results Of 524 LPTBs, 25.2% (n = 132) were NEB. Logistic regression revealed that NEB LPTBs were less likely if patients were delivered by their own doctor or their doctor's practice partner (OR 0.53,. However, NEB LPTBs were more likely in women who had experienced a previous stillbirth (OR 2.57, 95% CI 1.20-5.49).Conclusions Approximately one-quarter of LPTBs are NEB. Further research is needed to see if a review of the indications for LPTB, and subsequent reduction in NEB LPTBs, translates into improved neonatal outcomes and cost savings.

Prématurité modérée 34–37SA : description des causes et conséquences néonatales immédiates dans une maternité de niveau 2

“…Dans l'é tude plus ré cente de Morais et al [8], parmi les 524 femmes ayant accouché pré maturé ment entre 34SA et 36 SA + 6 j ; 25,2 % des indications de naissance induite n'é taient pas basé es sur l'Evidence Base Medicine, 57,6 % de ces naissances survenaient aprè s rupture pré maturé e des membranes.…”

“…Or, dans la litté rature, un quart des indications de dé clenchement entre 34 et 37 SA ne repose pas sur l'Evidence Based Medicine [7,8].…”

Preterm Birth Prevention: How Well Are We Really Doing? A Review of the Latest Literature

“…Another call for review of the indications for late PTB from a Canadian retrospective cohort revealed a 25.2 % rate of singleton deliveries for NEB indications. Those deliveries were less likely if the patients were delivered by their own doctor or their doctor's practice partner [59]. A survey among ACOG fellows implied that many obstetricians underestimate long-term neurodevelopmental outcomes among infants born late preterm [60].…”

Preterm births in Iceland 1997‐2016: Preterm birth rates by gestational age groups and type of preterm birth

“…1,8,9 However, these indications may not explain the increase in iatrogenic preterm births as some of them have been found to be avoidable 10 and even not medically indicated. 11,12 The preterm birth rate in Iceland was 4.8% in 1972-1981 13 and 5.4% in 2010. 14 In Landspitali University Hospital (Iceland's only tertiary hospital with 75% of all births and over 90% of all preterm births), the preterm birth rate had been stable around 6.7% in the previous years; however, it increased to 7.9% in 2016.…”