Publication: The overlap between miscarriage and extreme preterm birth in a limited-resource setting on the thailand-myanmar border: A population cohort study [version 3; referees: 2 approved, 2 approved with reservations]
Issued Date
2018-01-01
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ISSN
2398502X
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2-s2.0-85062786761
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Mahidol University
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SCOPUS
Bibliographic Citation
Wellcome Open Research. Vol.1, (2018)
Suggested Citation
Rose McGready, Moo Kho Paw, Jacher Wiladphaingern, Aung Myat Min, Verena I. Carrara, Kerryn A. Moore, Sasithon Pukrittayakamee, François H. Nosten The overlap between miscarriage and extreme preterm birth in a limited-resource setting on the thailand-myanmar border: A population cohort study [version 3; referees: 2 approved, 2 approved with reservations]. Wellcome Open Research. Vol.1, (2018). doi:10.12688/wellcomeopenres.10352.3 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/45340
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Title
The overlap between miscarriage and extreme preterm birth in a limited-resource setting on the thailand-myanmar border: A population cohort study [version 3; referees: 2 approved, 2 approved with reservations]
Abstract
© 2018 McGready R et al. Background: No universal demarcation of gestational age distinguishes miscarriage and stillbirth or extreme preterm birth (exPTB). This study provides a synopsis of outcome between 22 to <28 weeks gestation from a low resource setting. Methods: A retrospective record review of a population on the Thailand-Myanmar border was conducted. Outcomes were classified as miscarriage, late expulsion of products between 22 to < 28 weeks gestation with evidence of non-viability (mostly ultrasound absent fetal heart beat) prior to 22 weeks; or exPTB (stillbirth/live born) between 22 to < 28 weeks gestation when the fetus was viable at ≥22 weeks. Termination of pregnancy and gestational trophoblastic disease were excluded. Results: From 1995-2015, 80.9% (50,046/ 61,829) of registered women had a known pregnancy outcome, of whom 99.8% (49,931) had a known gestational age. Delivery between 22 to <28 weeks gestation included 0.9% (472/49,931) of pregnancies after removing 18 cases (3.8%) who met an exclusion criteria. Most pregnancies had an ultrasound: 72.5% (n=329/454); 43.6% (n=197) were classified as miscarriage and 56.4% (n=257) exPTB. Individual record review of miscarriages estimated that fetal death had occurred at a median of 16 weeks, despite late expulsion between 22 to <28 weeks. With available data (n=252, 5 missing) the proportion of stillbirth was 47.6% (n=120), congenital abnormality 10.5% (24/228, 29 missing) and neonatal death was 98.5% (128/131, 1 missing). Introduction of ultrasound was associated with a 2-times higher odds of classification of outcome as exPTB rather than miscarriage. Conclusion: In this low resource setting few (<1%) pregnancy outcomes occurred in the 22 to <28 weeks gestational window; four in ten were miscarriage (late expulsion) and neonatal mortality approached 100%. In the scale-up to preventable newborns deaths (at least initially) greater benefits will be obtained by focusing on the viable newborns of ≥ 28 weeks gestation.