Obstetric interventions for babies born before 28 weeks of gestation in Europe: results of the MOSAIC study

BJOG. 2009 Oct;116(11):1481-91. doi: 10.1111/j.1471-0528.2009.02235.x. Epub 2009 Jul 7.


Objective: To describe obstetric intervention for extremely preterm births in ten European regions and assess its impact on mortality and short term morbidity.

Design: Prospective observational cohort study.

Setting: Ten regions from nine countries participating in the 'Models of Organising Access to Intensive Care for Very Preterm Babies in Europe' (MOSAIC) project.

Population: All births from 22 to 29 weeks of gestation (n = 4146) in 2003, excluding terminations of pregnancy.

Methods: Comparison of three obstetric interventions (antenatal corticosteroids, antenatal transfer and caesarean section for fetal indication) rates at 22-23, 24-25 and 26-27 weeks to that at 28-29 weeks and the association of the level of intervention with pregnancy outcome.

Main outcome measures: Use of antenatal corticosteroids, antenatal transfer and caesarean section by two-week gestational age groups as well as a composite score of these three interventions. Outcomes included stillbirth, in-hospital mortality and intraventricular haemorrhage (IVH) grades III and IV and/or periventricular leucomalacia (PVL) and bronchopulmonary dysplasia (BPD).

Results: There were large differences between regions in interventions for births at 22-23 and 24-25 weeks. Differences were most pronounced at 24-25 weeks; in some regions these babies received the same care as babies of 28-29 weeks, whereas elsewhere levels of intervention were distinctly lower. Before 26 weeks and especially at 24-25 weeks, there was an association between the composite intervention score and mortality. No association was observed at 26-27 weeks. For survivors at 24-25 weeks, the intervention score was associated with higher rates of BPD, but not with IVH or PVL.

Conclusions: There are large differences between European regions in obstetric practices at the lower limit of viability and these are related to outcome, especially at 24-25 weeks.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage
  • Bronchopulmonary Dysplasia / epidemiology
  • Bronchopulmonary Dysplasia / therapy
  • Cerebral Hemorrhage / epidemiology
  • Cerebral Hemorrhage / therapy
  • Europe / epidemiology
  • Female
  • Gestational Age
  • Hospital Mortality
  • Humans
  • Infant, Newborn
  • Infant, Premature*
  • Infant, Premature, Diseases / epidemiology
  • Infant, Premature, Diseases / therapy*
  • Intensive Care, Neonatal / statistics & numerical data*
  • Leukomalacia, Periventricular / epidemiology
  • Leukomalacia, Periventricular / therapy
  • Patient Transfer
  • Pregnancy
  • Pregnancy Outcome
  • Premature Birth / epidemiology*
  • Prospective Studies
  • Stillbirth / epidemiology
  • Treatment Outcome


  • Adrenal Cortex Hormones