000			05261nam a22006617a 4500
008			160115s20152015 xxu||||| |||| 00| 0 eng d
022			_a1097-6868
040			_aOvid MEDLINE(R)
099			_a26164696
245			_aSerious maternal complications after early preterm delivery (24-33 weeks' gestation).
251			_aAmerican Journal of Obstetrics & Gynecology. 213(4):538.e1-9, 2015 Oct.
252			_aAm J Obstet Gynecol. 213(4):538.e1-9, 2015 Oct.
253			_aAmerican journal of obstetrics and gynecology
260			_c2015
260			_fFY2016
266			_d2016-01-15
501			_aAvailable online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
520			_aCONCLUSION: 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.
520			_aOBJECTIVE: 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.
520			_aRESULTS: 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).
520			_aSTUDY 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.
546			_aEnglish
650			_a*Cesarean Section/mt [Methods]
650			_a*Gestational Age
650			_a*Postoperative Complications/ep [Epidemiology]
650			_a*Postpartum Hemorrhage/ep [Epidemiology]
650			_a*Premature Birth
650			_aAdult
650			_aAnti-Bacterial Agents/tu [Therapeutic Use]
650			_aBlood Transfusion/ut [Utilization]
650			_aCohort Studies
650			_aDelivery, Obstetric/mt [Methods]
650			_aEndometritis/dt [Drug Therapy]
650			_aEndometritis/ep [Epidemiology]
650			_aFemale
650			_aHumans
650			_aHysterectomy/ut [Utilization]
650			_aIntensive Care Units/ut [Utilization]
650			_aMaternal Mortality
650			_aPostpartum Hemorrhage/su [Surgery]
650			_aPregnancy
650			_aPregnancy Trimester, Second
650			_aPregnancy Trimester, Third
650			_aRetrospective Studies
650			_aRisk
650			_aSurgical Wound Dehiscence/ep [Epidemiology]
650			_aSurgical Wound Infection/dt [Drug Therapy]
650			_aSurgical Wound Infection/ep [Epidemiology]
650			_aYoung Adult
651			_aMedStar Washington Hospital Center
656			_aObstetrics and Gynecology, Maternal-Fetal Medicine
657			_aJournal Article
657			_aResearch Support, N.I.H., Extramural
700			_aReddy, Uma M
790			_aBailit JL, Blackwell SC, Caritis SN, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Grobman WA, Leveno KJ, Prasad M, Reddy UM, Rice MM, Rouse DJ, Saade GR, Sorokin Y, Thorp JM Jr, Tita AT, Tolosa JE, Varner MW, Wapner RJ
856			_uhttp://dx.doi.org/10.1016/j.ajog.2015.06.064 _zhttp://dx.doi.org/10.1016/j.ajog.2015.06.064
942			_cART _dArticle
999			_c1229 _d1229