Serious maternal complications after early preterm delivery (24-33 weeks' gestation).
Serious maternal complications after early preterm delivery (24-33 weeks' gestation).
- 2015
Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
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 intensive care unit admission for early preterm births requiring cesarean delivery.Copyright Published by Elsevier Inc. OBJECTIVE: 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. 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 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). STUDY DESIGN: 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.
English
1097-6868
*Cesarean Section/mt [Methods]
*Gestational Age
*Postoperative Complications/ep [Epidemiology]
*Postpartum Hemorrhage/ep [Epidemiology]
*Premature Birth
Adult
Anti-Bacterial Agents/tu [Therapeutic Use]
Blood Transfusion/ut [Utilization]
Cohort Studies
Delivery, Obstetric/mt [Methods]
Endometritis/dt [Drug Therapy]
Endometritis/ep [Epidemiology]
Female
Humans
Hysterectomy/ut [Utilization]
Intensive Care Units/ut [Utilization]
Maternal Mortality
Postpartum Hemorrhage/su [Surgery]
Pregnancy
Pregnancy Trimester, Second
Pregnancy Trimester, Third
Retrospective Studies
Risk
Surgical Wound Dehiscence/ep [Epidemiology]
Surgical Wound Infection/dt [Drug Therapy]
Surgical Wound Infection/ep [Epidemiology]
Young Adult
MedStar Washington Hospital Center
Obstetrics and Gynecology, Maternal-Fetal Medicine
Journal Article
Research Support, N.I.H., Extramural
Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
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 intensive care unit admission for early preterm births requiring cesarean delivery.Copyright Published by Elsevier Inc. OBJECTIVE: 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. 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 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). STUDY DESIGN: 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.
English
1097-6868
*Cesarean Section/mt [Methods]
*Gestational Age
*Postoperative Complications/ep [Epidemiology]
*Postpartum Hemorrhage/ep [Epidemiology]
*Premature Birth
Adult
Anti-Bacterial Agents/tu [Therapeutic Use]
Blood Transfusion/ut [Utilization]
Cohort Studies
Delivery, Obstetric/mt [Methods]
Endometritis/dt [Drug Therapy]
Endometritis/ep [Epidemiology]
Female
Humans
Hysterectomy/ut [Utilization]
Intensive Care Units/ut [Utilization]
Maternal Mortality
Postpartum Hemorrhage/su [Surgery]
Pregnancy
Pregnancy Trimester, Second
Pregnancy Trimester, Third
Retrospective Studies
Risk
Surgical Wound Dehiscence/ep [Epidemiology]
Surgical Wound Infection/dt [Drug Therapy]
Surgical Wound Infection/ep [Epidemiology]
Young Adult
MedStar Washington Hospital Center
Obstetrics and Gynecology, Maternal-Fetal Medicine
Journal Article
Research Support, N.I.H., Extramural