Joseph has used such data to propose a new theory of obstetrics. He argues the efficacy of thoroughly obstetrics should be assessed by evaluating outcomes for all fetuses at risk—that is, all fetuses at 20 weeks of gestation or above.36 By this approach,

the proper measure of the success of obstetrics should not be preterm birth rates or Inhibitors,research,lifescience,medical infant mortality. Instead, it should assess survival rates for all living fetuses from 20 weeks of gestation onward. He explains the difference as follows: Under the traditional model of perinatal death, neonatal deaths occur among infants in the first month after birth and the unborn fetus is not a candidate for neonatal death. However from Inhibitors,research,lifescience,medical a broad biological, obstetric and ultimately epidemiologic point of view,

a fetus at any gestation is at risk of stillbirth and neonatal death at that gestation. If one considers a woman at 28 weeks gestation with severe preeclampsia and fetal compromise, the risk of stillbirth is easy to conceptualize. The risk of neonatal death is substantial as well and can follow either premature labor or medically indicated delivery. The same risks apply in concept to a woman with a healthy pregnancy at 28 weeks gestation, despite the magnitude of the risks being considerably smaller. Thus, although neonatal deaths literally occur among infants, fetuses can be considered candidates for neonatal Inhibitors,research,lifescience,medical death as well.36 Lisonkova and colleagues analyzed pregnancy outcome data in the United States and Canada, using this approach, and showed that higher rates

of medically induced preterm births were associated with decreased fetal mortality, infant mortality, and severe neonatal morbidity.37 Such data suggest Inhibitors,research,lifescience,medical that the rise Inhibitors,research,lifescience,medical in preterm birth may not be such a bad thing. It may reflect better obstetrical care with more sensitive assessments of fetal distress. When coupled with excellent neonatal intensive care, it may lead to improved outcomes for babies compared to an approach to obstetrics that is oriented towards maximizing rates of term birth. Some have raised concerns, however, about the over-use of medically Anacetrapib induced preterm birth, the consequent rise in near-term deliveries, and the morbidity associated with near-term birth, even when excellent neonatal care is available. For example, Woythaler and colleagues studied neurodevelopmental outcomes at 2 years for babies born after 37 weeks and those born between 34 and 37 weeks (“late preterm”). They showed that the late preterm babies had more physical, cognitive, and developmental delay.38 Of course, such studies have the same problems of confounding as do all non-randomized trials. We do not know if outcomes were worse because the babies were born preterm, or whether the babies were born preterm because they had problems that led to poorer neurodevelopmental outcomes.