Morbidity and mortality associated with mode of delivery for breech periviable deliveries

OBJECTIVE: The purpose of this study was to estimate the odds of morbidity and death that are associated with cesarean delivery, compared with vaginal delivery, for breech fetuses who are delivered from 23-24 6/7 weeks' gestational age. STUDY DESIGN: We conducted a retrospective cohort study of state-level maternal and infant hospital discharge data that were linked to vital statistics for breech deliveries that occurred from 23-24 6/7 weeks' gestation in California, Missouri, and Pennsylvania from 2000-2009 (N = 1854). Analyses were stratified by gestational age (23-23 6/7 vs 24-24 6/7 weeks' gestation). RESULTS: Cesarean delivery was performed for 46% (335 fetuses) and 77% (856 fetuses) of 23- and 24-week breech fetuses. In multivariable analyses, overall survival was greater for cesarean-born neonates (adjusted odds ratio [AOR], 3.98; 95% confidence interval [CI], 2.24-7.06; AOR, 2.91; 95% CI, 1.76-4.81, respectively). When delivered for nonemergent indications, cesarean-born survivors were more than twice as likely to experience major morbidity (intraventricular hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, asphyxia composite; AOR, 2.83; 95% CI, 1.37-5.84; AOR, 2.07; 95% CI, 1.11-3.86 at 23 and 24 weeks' gestation, respectively). Among intubated neonates, despite a short-term survival advantage, there was no difference in survival to >6-month corrected age (AOR, 1.77; 95% CI, 0.83-3.74; AOR, 1.50; 95% CI, 0.81-2.76, respectively). There was no difference in survival for intubated 23-week neonates who were delivered by cesarean for nonemergent indications or cesarean-born neonates who weighed <500 g. CONCLUSION: Cesarean delivery increased overall survival and major morbidity for breech periviable neonates. However, among intubated neonates, despite a short-term survival advantage, there was no difference in 6-month survival. Also, cesarean delivery did not increase survival for neonates who weighed <500 g. Patients and providers should discuss explicitly the trade-offs related to neonatal death and morbidity, maternal morbidity, and implications for future pregnancies

Weight perceptions in older adults: findings from the English Longitudinal Study of Ageing

Objectives: To explore weight perceptions in a large, nationally-representative sample of older adults, and the extent to which they differ according to age and perceived health status. Setting: England. Participants: 5,240 men and women (≥50y) participating in the English Longitudinal Study of Ageing (2016/17). Main outcome measures: Weight perception was self-reported as too heavy, too light, or about right. Results: The majority of older adults endorsed a weight perception that matched their (objectively measured) BMI classification. However, one in ten (9.9%) older adults classified by BMI as normal-weight (18.5-24.9kg/m2) felt too light, with women at the upper end of the older age spectrum (OR=1.04, 95%CI=1.01-1.09), and men (OR=3.70, 95%CI=1.88-7.28) and women (OR=2.61, 95%CI=1.27-5.35) in poorer health more likely to do so. Almost half (44.8%) of older adults classified as overweight (25-29.9kg/m2) and one in ten (10.3%) classified as obese (≥30kg/m2) felt about the right weight, with this observed more frequently among men and women at the upper end of the older age spectrum (OR range 1.04-1.06). Conclusion: Older adults’ perceptions of their own weight generally correspond with traditional BMI cut-offs for normal-weight, overweight, and obesity. However, a substantial minority ‘underestimate’ their weight status, with those at the upper end of the age spectrum and those in poorer health more likely to do so