The Impact of Mode of Delivery on Maternal and Neonatal Outcomes during Periviable Birth (22–25 Weeks)

Abstract

Objective: To compare the maternal and neonatal complications of periviable birth by delivery route. Study Design: A retrospective cohort study of periviable deliveries (22w0d-25w6d) from 2013-2020 at a tertiary teaching institution was conducted. Deliveries were grouped by mode of delivery. Excluded deliveries included pregnancy termination, anomaly, or undesired neonatal resuscitation. The primary composite maternal outcome included death, intensive care admission, sepsis, surgical site infection, unplanned operation, or readmission. Secondary outcomes included maternal blood loss, length of stay, neonatal survival, bronchopulmonary dysplasia (BPD), interventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), patent ductus arteriosus (PDA), and retinopathy of prematurity (ROP). Outcomes were compared using student t-test, Wilcoxon-Mann-Whitney, and chi-squared tests. Relative risk (RR) and 95% confidence intervals (CI) were calculated with log binomial regression. P-values <0.05 were considered significant. Demographic and intervention variables associated with the outcome and the exposure were included in an adjusted relative risk (aRR) model. Subgroup analyses of singleton pregnancies and 22w0d-23w6d deliveries were conducted. Results: After exclusion, 230 deliveries were included in the cohort. Maternal characteristics were similar between cohorts. For the primary outcome, cesarean delivery was associated with a trend toward increased maternal morbidity (22.6% vs 10.7%, RR 2.11 [1.03-4.43] p-value 0.03, aRR 1.95 [0.94-4.03], p-value 0.07). Administration of magnesium sulfate, antenatal corticosteroids, and tocolytics were similar between cohorts. Neonatal survival to discharge was not different between the groups (54/83, 65.1% vs 118/191, 61.8%, aRR 0.93 [0.77-1.13]). Among the 172 neonates discharged alive, there was no difference in BPD, IVH, NEC, PDA, ROP, or intact survival. Conclusion: Periviable birth has a high rate of maternal morbidity with a trend toward higher risk following cesarean delivery. These risks should be included in shared decision making.

Association of mode of delivery with short‐term and neurodevelopmental outcomes in periviable singleton infants: A nationwide database study

“…18 When limited to periviable infants, recent retrospective cohort studies found no association between MOD and severe IVH. 11,19 Our results suggest that, despite the MOD being associated with the physiology of IVH, the influence is not sufficiently strong to be associated with severe IVH.…”

Clinical feature and predictive factor analysis for spontaneous regression of retinopathy of prematurity in a Chinese population

“…Obviously, the relationship between vaginal delivery and threshold ROP may be a link, although not necessarily a causal relationship [27] . During the natural delivery process, the mechanism of vaginal delivery and the stress dynamics may be harmful to the fetal cerebral blood vessels, leading to ischemia and subsequent reperfusion and/or oxidative stress, accompanied by related imbalance of hyperoxiahypoxia [28] . Both of the mechanisms can promote the release and formation of neoangiogenesis mediators induced by hypoxia.…”

The pregnancy at risk for delivery at the threshold of viability

“…No randomized controlled trial of cesarean delivery vs. vaginal delivery for periviable births has been conducted. A recent retrospective cohort study [16] of 274 periviable births in 230 mothers at 22–25 weeks gestational age by mode of delivery demonstrated no impact of route of delivery on neonatal survival or intact neonatal survival. Furthermore, head entrapment was rare during vaginal breech delivery.…”