title: 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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  The mortality risk of expectant management exceeds the risk of delivery at 39 weeks in all racial/ethnic groups, despite variation in absolute risks.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA. Electronic address: rosensteinm@obgyn.ucsf.edu.
authors.forename: Melissa G
authors.initials: MG
authors.lastname: Rosenstein
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Snowden
authors.affiliation: Department of Obstetrics and Gynecology, California Pacific Medical Center, San Francisco, CA.
authors.forename: Yvonne W
authors.initials: YW
authors.lastname: Cheng
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D001213:Asian / Q000706:statistics & numerical data; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D046689:Fetal Mortality / Q000208:ethnology*; D005865:Gestational Age; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000208:ethnology*; D007231:Infant, Newborn; D054238:Perinatal Mortality / Q000208:ethnology*; D011247:Pregnancy; D047928:Premature Birth / Q000401:mortality*; D012189:Retrospective Studies; D050497:Stillbirth / Q000208:ethnology; D057832:Watchful Waiting; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
keywords: expectant management; mortality risk; race/ethnicity; stillbirth