Should older women have antepartum testing to prevent unexplained stillbirth?
Obstet Gynecol. 2004 Jul;104(1):56-64.
Should older women have antepartum testing to prevent unexplained stillbirth?
Fretts RC, Elkin EB, Myers ER, Heffner LJ.
Harvard Medical Associates, Brigham and Women's Hospital and Harvard Medical
School, Boston, Massachusetts, USA. ruth_fretts@vmed.org
OBJECTIVE: Older women are at an increased risk for unexplained stillbirth late
in pregnancy. The purpose of this study was to compare 3 strategies for the
prevention of unexplained fetal death in women aged 35 years and older. We
compared usual care (no antepartum testing or induction before 41 weeks), weekly
testing at 37 weeks with induction after a positive test, and no testing with
induction at 41 weeks.
METHOD: We used a Markov model to quantify the risks and benefits of each
strategy in terms of the number of antepartum tests, inductions, and additional
cesarean deliveries per fetal death averted. Probability data used in the model
were derived from obstetrical databases and the literature.
RESULTS: Without a strategy of antepartum surveillance between 37 and 41 weeks,
women aged 35 years and older would experience 5.2 unexplained fetal deaths per
1,000 pregnancies. For nulliparous women 35 and older, weekly antepartum testing
initiated at 37 weeks would avert 3.9 fetal deaths per 1,000 pregnancies but
would require 863 antepartum tests, 71 inductions, and 14 additional cesarean
deliveries per fetal death averted. A strategy of no testing but induction at
41 weeks would avert 0.9 fetal deaths per 1,000 pregnancies and require 469
inductions and 219 additional cesareans per fetal death averted.
CONCLUSION: A strategy of antepartum testing in older women would reduce the
number of unexplained stillbirths at term and would result in fewer inductions
and cesareans per fetal death averted than a strategy of no antepartum testing
but induction at 41 weeks.
PMID: 15229001 [PubMed - indexed for MEDLINE]
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