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C-Sections Explain Jump in U.S. Preemie Births

Researchers suggest some of these procedures may just be matter of convenience

WEDNESDAY, May 28 (HealthDay News) -- Premature births of single babies in the United States have been on the rise in recent years, and a new report finds that Caesarean sections account for nearly all of the increase.

"I think this is the first time an in-depth analysis has been done on these two increasing problems," said Dr. Alan Fleischman, medical director and senior vice president of the March of Dimes. Investigators from the March of Dimes, the U.S. Centers for Disease Control and Prevention, and the Albert Einstein College of Medicine collaborated on the report, which was expected to be published in the June issue of Clinics in Perinatology.

Researchers looked at national birth data from 1996 to 2004, and found an increase of almost 60,000 singleton preterm births, most of those delivered by C-section. "The analysis revealed that 92 percent of the increase in singleton premature birth is due to C-sections," Fleischman said. "That is an amazing statistic."

While single-baby preterm births rose by about 10 percent during this nine-year period, the C-section rate for the group rose 36 percent, the researchers found.

Preterm birth -- delivery before 37 weeks of gestation -- boosts the risk of death in the first month of life. More than 520,000 babies are born too soon each year in the United States -- that's one in eight. Those born "late preterm," from 34 to 36 weeks, accounted for most of the rise in the preterm birth rates for singletons. And the babies face not only a higher risk of death, but also a host of health problems such as respiratory difficulties, feeding problems, jaundice and delayed brain development.

Fleischman said the advice about preterm birth from the American College of Obstetricians and Gynecologists is clear. "ACOG says no one should be induced before 39 weeks unless there are clear medical indications," he noted. The March of Dimes is in agreement with that advice, he added.

Among the medical reasons to induce are uterine infection or high blood pressure caused by the pregnancy (preeclampsia), among others.

While there are clear medical indications for C-sections, Fleischman suspects the "convenience" factor may be coming into play.

Experts have long suspected that the rise in C-sections was linked to an increased in preterm births, Fleischman said. "The challenge now is to sort out what percent of these C-sections are based on less than optimal medical indications," he said.

As for women requesting C-sections for convenience, Fleischman said that when they consider requesting early delivery before 39 weeks, they really need to understand that babies born before that time are at risk for problems.

The message of the study is clear, said Dr. Jennifer Wu, an obstetrician- gynecologist at Lenox Hill Hospital in New York City. "This is studying a large population, and it's warning doctors about the risk of an early delivery," she said.

All factors need to be balanced when trying to decide whether inducing an early delivery is wise, she said.

"If you are inducing early, it should be [for] a medical reason," Wu said. One example is a patient at risk of stillbirth, she said. "If you advise a patient, 'You are at risk for stillbirth, we would like to induce you early,' you have to make sure the [child's] lungs are mature."

If an obstetrician suggests delivering before 39 weeks, Fleischman advised women to ask why it is being suggested and what will happen if they do not. Those questions, in turn, he said, will hopefully help the physician and the patient make the best decision.

More information

To learn more about preterm labor, visit the March of Dimes.

SOURCES: Alan R. Fleischman, M.D., medical director and senior vice president, March of Dimes, White Plains, N.Y.; Jennifer Wu, M.D., obstetrician and gynecologist, Lenox Hill Hospital, New York City; June 2008, Clinics in Perinatology

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