Serious maternal complications after early preterm delivery (24-33 weeks’ gestation)

Abstract

OBJECTIVE To describe the prevalence of serious maternal complications following early preterm birth by gestational age (GA), delivery route and type of cesarean incision. STUDY DESIGN Trained personnel abstracted data from maternal and neonatal charts for all deliveries on randomly selected days representing 1/3 of deliveries across 25 US hospitals over 3 years (n=115,502). All women delivering non-anomalous singletons between 23 and 33 weeks’ gestation were included. Women were excluded for antepartum stillbirth and highly morbid conditions for which route of delivery would not likely impact morbidity including non-reassuring fetal status, cord prolapse, placenta previa, placenta accreta, placental abruption, and severe, unstable maternal conditions (cardiopulmonary collapse, acute respiratory distress syndrome, seizures). Serious maternal complications were defined as: hemorrhage (blood loss ≥1500 mL, blood transfusion, or hysterectomy for hemorrhage); infection (endometritis, wound dehiscence, or wound infection requiring antibiotics, reopening or unexpected procedure); ICU admission; or death. Delivery route was categorized as classical cesarean delivery (CCD), low transverse cesarean delivery (LTCD), low vertical cesarean delivery (LVCD), and vaginal delivery (VD). Association of delivery route with complications was estimated using multivariable regression models yielding adjusted relative risks (aRR) controlling for maternal age, race, body mass index, hypertension, diabetes, preterm premature rupture of membranes, preterm labor, GA, and hospital of delivery. RESULTS Of 2659 women who met criteria for inclusion in this analysis, 8.6% of women experienced serious maternal complications. Complications were associated with GA and were highest between 23–27 weeks of gestation. The frequency of complications was associated with delivery route; compared with 3.5% of SVD, 23.0% of CCD (aRR 3.54, 95%CI 2.29–5.48), 12.1% of LTCD (aRR 2.59, 95%CI 1.77–3.77), and 10.3% of LVCD (aRR 2.27, 95%CI 0.68–7.55) experienced complications. There was no significant difference in complication rates between CCD and LTCD (aRR 1.37, 95%CI 0.95–1.97) or between CCD and LVCD (aRR 1.56, 95%CI 0.48–5.07). CONCLUSION The risk of maternal complications after early preterm delivery is substantial, particularly in women who undergo cesarean delivery. Obstetricians need to be prepared to manage potential hemorrhage, infection and ICU admission for early preterm births requiring cesarean delivery.

Shared decision making for infants born at the threshold of viability: a prognosis-based guideline

“…Fifteen to twenty percent of cesareans at o26 weeks GA will necessitate a classical/ vertical incision on the uterus, which is associated with a further increase in short-term complications for the mother, including hemorrhage, infection, ileus and possibly increased risk of subsequent subfertility. 44,[46][47][48][49] Most importantly, vertical uterine incisions carry an increased risk (~2%) of rupture during future pregnancies. 44,[46][47][48] Delivery by repeat cesarean after a classical cesarean section is considered mandatory.…”

Adaptation of the inflammatory immune response across pregnancy and postpartum in Black and White women

“…These outcomes have been linked with dysregulation of inflammatory processes (Kuklina, Ayala & Callaghan 2009, Reddy et al 2015, Behrman, Stith Butler 2007, Mendola et al 2015, Hamilton et al 2015). Better understanding of typical changes in immune function during healthy pregnancy is need to recognize patterns of immune-dysregulation.…”

Postpartum Health Services Requested by Mothers with Newborns Receiving Intensive Care

“…In recent analyses of delivery records sampled from 25 hospitals within the maternal-fetal medicine units network [3, 23], birth of a preterm infant at 23 to <34 weeks was associated with higher rates of pre-gestational diabetes, hypertension, tobacco use during pregnancy, and c-section than birth of a term infant. Compared with birth at 39 to <40 weeks, birth of an infant at 23 to <34 weeks was associated with a 9.10-fold odds of severe maternal morbidity [13].…”

“…Compared with birth at 39 to <40 weeks, birth of an infant at 23 to <34 weeks was associated with a 9.10-fold odds of severe maternal morbidity [13]. Reddy et al [23] found higher rates of composite serious maternal complications among mothers of infants born at 23–27 weeks (11.5 %), compared with those born at 28–31 (9.5 %) and 32–33 weeks (6.3 %), p  < .001. These analyses underscore the degree of medical need among mothers of medically fragile infants who must recover from birth and manage their chronic health conditions while caring for a critically ill infant.…”