The mortality risk of expectant management compared with delivery stratified by gestational age and race and ethnicity

Abstract

Objective: The objective of the study was to compare the mortality risk of expectant management with the risk of delivery at each week of term pregnancy in 4 racial/ethnic groups.

Study design: This was a retrospective cohort study of all nonanomalous, term deliveries in California from 1997 to 2006 among white, black, Hispanic, and Asian women. In each racial/ethnic group, we compared the risk of infant death at each week with a composite risk representing the mortality risk of 1 week of expectant management.

Results: The risk of stillbirth and infant death is highest in black women (stillbirth risk: 18.0 per 10,000, infant death: 24.4 per 10,000, compared with 9.4 per 10,000 and 10.8 per 10,000 in white women, respectively; P < .001). Although absolute risks differ by race/ethnicity, the composite risk of expectant management does not surpass the risk of delivery until 39 weeks in any group. At 39 weeks these absolute risk differences are low, however, with a number needed to deliver to prevent 1 death ranging from 751 (among black women) to 2587 (among Asian women).

Conclusion: The mortality risk of expectant management exceeds the risk of delivery at 39 weeks in all racial/ethnic groups, despite variation in absolute risks.

Keywords: expectant management; mortality risk; race/ethnicity; stillbirth.