Serious Maternal Complications after Early Preterm Delivery (24-33 Weeks’ Gestation)

Citation

Reddy, Uma M.; Rice, Madeline Murguia; Grobman, William A.; Bailit, Jennifer L.; Wapner, Ronald J.; Varner, Michael W.; Leveno, Kenneth J.; Caritis, Steve N.; Prasad, Mona; & Tita, Alan T. N., et al. (2015). Serious Maternal Complications after Early Preterm Delivery (24-33 Weeks’ Gestation). American Journal of Obstetrics & Gynecology, 213(4), 538.e1-9. PMCID: PMC4587283

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.

URL

http://dx.doi.org/10.1016/j.ajog.2015.06.064

Reference Type

Journal Article

Year Published

2015

Journal Title

American Journal of Obstetrics & Gynecology

Author(s)

Reddy, Uma M.
Rice, Madeline Murguia
Grobman, William A.
Bailit, Jennifer L.
Wapner, Ronald J.
Varner, Michael W.
Leveno, Kenneth J.
Caritis, Steve N.
Prasad, Mona
Tita, Alan T. N.
Saade, George R.
Sorokin, Yoram
Rouse, Dwight J.
Blackwell, Sean C.
Tolosa, Jorge E., for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network, [
John M. Thorp, Jr., Member
]

PMCID

PMC4587283