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

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

doi:10.1016/j.ajog.2015.06.064

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

Journal article

Peer reviewed

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

Uma M Reddy, Madeline Murguia Rice, William A Grobman, Jennifer L Bailit, Ronald J Wapner, Michael W Varner, John M Thorp Jr, Kenneth J Leveno, Steve N Caritis, Mona Prasad, …

American journal of obstetrics and gynecology, Vol.213(4), pp.538.e1-538.e9

10/2015

DOI: 10.1016/j.ajog.2015.06.064

PMCID: PMC4587283

PMID: 26164696

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Abstract

We sought to describe the prevalence of serious maternal complications following early preterm birth by gestational age (GA), delivery route, and type of cesarean incision. Trained personnel abstracted data from maternal and neonatal charts for all deliveries on randomly selected days representing one third of deliveries across 25 US hospitals over 3 years (n = 115,502). All women delivering nonanomalous singletons between 23-33 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 nonreassuring fetal status, cord prolapse, placenta previa, placenta accreta, placental abruption, and severe and 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), intensive care unit admission, or death. Delivery route was categorized as classic cesarean delivery (CCD), low transverse cesarean delivery (LTCD), low vertical cesarean delivery (LVCD), and vaginal delivery. 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. 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 vaginal delivery, 23.0% of CCD (aRR, 3.54; 95% confidence interval (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). 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 intensive care unit admission for early preterm births requiring cesarean delivery.

Pregnancy

Adult

Anti-Bacterial Agents - therapeutic use

Blood Transfusion - statistics & numerical data

Cesarean Section - methods

Cohort Studies

Delivery, Obstetric - methods

Endometritis - drug therapy

Endometritis - epidemiology

Female

Gestational Age

Humans

Hysterectomy - statistics & numerical data

Intensive Care Units - statistics & numerical data

Maternal Mortality

Postoperative Complications - epidemiology

Postpartum Hemorrhage - epidemiology

Postpartum Hemorrhage - surgery

Pregnancy Trimester, Second

Pregnancy Trimester, Third

Premature Birth

Retrospective Studies

Risk

Surgical Wound Dehiscence - epidemiology

Surgical Wound Infection - drug therapy

Surgical Wound Infection - epidemiology

Young Adult

Details

Title: Subtitle: Serious maternal complications after early preterm delivery (24-33 weeks' gestation)
Creators: Uma M Reddy - National Institutes of Health
Madeline Murguia Rice - George Washington University
William A Grobman - Northwestern University
Jennifer L Bailit - Case Western Reserve University
Ronald J Wapner - Columbia University
Michael W Varner - University of Utah
John M Thorp Jr - Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC
Kenneth J Leveno - The University of Texas at Dallas
Steve N Caritis - University of Pittsburgh
Mona Prasad - The Ohio State University
Alan T N Tita - University of Alabama
George R Saade - The University of Texas Medical Branch at Galveston
Yoram Sorokin - Wayne State University
Dwight J Rouse - Brown University
Sean C Blackwell - The University of Texas at Austin
Jorge E Tolosa - Oregon Health & Science University
Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
Contributors: M Santillan (Contributor) - University of Iowa, Obstetrics and Gynecology
Resource Type: Journal article
Publication Details: American journal of obstetrics and gynecology, Vol.213(4), pp.538.e1-538.e9
DOI: 10.1016/j.ajog.2015.06.064
PMID: 26164696
PMCID: PMC4587283
NLM abbreviation: Am J Obstet Gynecol
ISSN: 0002-9378
eISSN: 1097-6868
Grant note: HD40485 / NICHD NIH HHS 5UL1 RR025764 / NCRR NIH HHS Z99 HD999999 / Intramural NIH HHS U10 HD027915 / NICHD NIH HHS UG1 HD040545 / NICHD NIH HHS U10 HD021410 / NICHD NIH HHS UG1 HD027915 / NICHD NIH HHS U10 HD040500 / NICHD NIH HHS UL1 RR025764 / NCRR NIH HHS UG1 HD034116 / NICHD NIH HHS UG1 HD053097 / NICHD NIH HHS HD40545 / NICHD NIH HHS HD53118 / NICHD NIH HHS HD27869 / NICHD NIH HHS HD34208 / NICHD NIH HHS U10 HD034116 / NICHD NIH HHS HD40544 / NICHD NIH HHS UG1 HD040500 / NICHD NIH HHS U10 HD053097 / NICHD NIH HHS U10 HD036801 / NICHD NIH HHS U10 HD053118 / NICHD NIH HHS HD27917 / NICHD NIH HHS U10 HD040545 / NICHD NIH HHS HD40560 / NICHD NIH HHS U10 HD040544 / NICHD NIH HHS UL1 RR024989 / NCRR NIH HHS P2C HD050924 / NICHD NIH HHS U10 HD040512 / NICHD NIH HHS HD53097 / NICHD NIH HHS U10 HD034208 / NICHD NIH HHS UG1 HD040485 / NICHD NIH HHS HD36801 / NICHD NIH HHS HD40512 / NICHD NIH HHS U10 HD040560 / NICHD NIH HHS U10 HD027869 / NICHD NIH HHS HD34116 / NICHD NIH HHS U10 HD027917 / NICHD NIH HHS UG1 HD034208 / NICHD NIH HHS HD21410 / NICHD NIH HHS UG1 HD040560 / NICHD NIH HHS HD27915 / NICHD NIH HHS UG1 HD040544 / NICHD NIH HHS UG1 HD040512 / NICHD NIH HHS UG1 HD027869 / NICHD NIH HHS UL1 TR000439 / NCATS NIH HHS U10 HD040485 / NICHD NIH HHS HD40500 / NICHD NIH HHS U01 HD036801 / NICHD NIH HHS
Language: English
Date published: 10/2015
Academic Unit: Obstetrics and Gynecology
Record Identifier: 9984318220802771

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