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, 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, C. Spong, S. Tolivaisa, M. Talucci, M. Zylfijaj & 126 others Z. Reid, R. Leed, J. Benson, S. Forester, C. Kitto, S. Davis, M. Falk, C. Perez, K. Hill, A. Sowles, J. Postma, S. Alexander, G. Andersen, V. Scott, V. Morby, K. Jolley, J. Miller, B. Berg, K. Dorman, J. Mitchell, E. Kaluta, K. Clark, K. Spicer, S. Timlin, K. Wilson, L. Moseley, M. Santillan, J. Price, K. Buentipo, V. Bludau, T. Thomas, L. Fay, C. Melton, J. Kingsbery, R. Benezue, H. Simhan, M. Bickus, D. Fischer, T. Kamon, D. Deangelis, B. Mercer, C. Milluzzi, W. Dalton, T. Dotson, P. McDonald, C. Brezine, A. McGrail, C. Latimer, L. Guzzo, F. Johnson, L. Gerwig, S. Fyffe, D. Loux, S. Frantz, D. Cline, S. Wylie, J. Iams, M. Wallace, A. Northen, J. Grant, C. Colquitt, D. Rouse, W. Andrews, G. Mallett, M. Ramos-Brinson, A. Roy, L. Stein, P. Campbell, C. Collins, N. Jackson, M. Dinsmoor, J. Senka, K. Paychek, A. Peaceman, J. Moss, A. Salazar, A. Acosta, G. Hankins, N. Hauff, L. Palmer, P. Lockhart, D. Driscoll, L. Wynn, C. Sudz, D. Dengate, C. Girard, S. Field, P. Breault, F. Smith, N. Annunziata, D. Allard, J. Silva, M. Gamage, J. Hunt, J. Tillinghast, N. Corcoran, M. Jimenez, F. Ortiz, P. Givens, B. Rech, C. Moran, M. Hutchinson, Z. Spears, C. Carreno, B. Heaps, G. Zamora, J. Seguin, M. Rincon, J. Snyder, C. Farrar, E. Lairson, C. Bonino, W. Smith, K. Beach, S. Van Dyke, S. Butcher, E. Thom, Y. Zhao, P. McGee, V. Momirova, R. Palugod, B. Reamer, M. Larsen, T. Spangler, V. Bhandaru, J. P. Vandorsten

*Corresponding author for this work

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

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. 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. 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). 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.

Original languageEnglish (US)
Pages (from-to)538.e1-538.e9
JournalAmerican journal of obstetrics and gynecology
Volume213
Issue number4
DOIs
StatePublished - Oct 1 2015

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Mothers
Pregnancy
Confidence Intervals
Gestational Age
Premature Birth
Wound Infection
Hemorrhage
Intensive Care Units
Placenta Accreta
Placenta Previa
Abruptio Placentae
Endometritis
Fetal Distress
Stillbirth
Premature Obstetric Labor
Prolapse
Adult Respiratory Distress Syndrome
Maternal Age
Hysterectomy
Blood Transfusion

Keywords

  • classic cesarean delivery
  • early preterm delivery
  • hemorrhage
  • infection
  • intensive care unit admission
  • maternal morbidity

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Reddy, U. M., Rice, M. M., Grobman, W. A., Bailit, J. L., Wapner, R. J., Varner, M. W., ... Vandorsten, J. P. (2015). Serious maternal complications after early preterm delivery (24-33 weeks' gestation). American journal of obstetrics and gynecology, 213(4), 538.e1-538.e9. https://doi.org/10.1016/j.ajog.2015.06.064
Reddy, Uma M. ; Rice, Madeline Murguia ; Grobman, William A. ; Bailit, Jennifer L. ; Wapner, Ronald J. ; Varner, Michael W. ; Thorp, John M. ; 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. ; Spong, C. ; Tolivaisa, S. ; Talucci, M. ; Zylfijaj, M. ; Reid, Z. ; Leed, R. ; Benson, J. ; Forester, S. ; Kitto, C. ; Davis, S. ; Falk, M. ; Perez, C. ; Hill, K. ; Sowles, A. ; Postma, J. ; Alexander, S. ; Andersen, G. ; Scott, V. ; Morby, V. ; Jolley, K. ; Miller, J. ; Berg, B. ; Dorman, K. ; Mitchell, J. ; Kaluta, E. ; Clark, K. ; Spicer, K. ; Timlin, S. ; Wilson, K. ; Moseley, L. ; Santillan, M. ; Price, J. ; Buentipo, K. ; Bludau, V. ; Thomas, T. ; Fay, L. ; Melton, C. ; Kingsbery, J. ; Benezue, R. ; Simhan, H. ; Bickus, M. ; Fischer, D. ; Kamon, T. ; Deangelis, D. ; Mercer, B. ; Milluzzi, C. ; Dalton, W. ; Dotson, T. ; McDonald, P. ; Brezine, C. ; McGrail, A. ; Latimer, C. ; Guzzo, L. ; Johnson, F. ; Gerwig, L. ; Fyffe, S. ; Loux, D. ; Frantz, S. ; Cline, D. ; Wylie, S. ; Iams, J. ; Wallace, M. ; Northen, A. ; Grant, J. ; Colquitt, C. ; Rouse, D. ; Andrews, W. ; Mallett, G. ; Ramos-Brinson, M. ; Roy, A. ; Stein, L. ; Campbell, P. ; Collins, C. ; Jackson, N. ; Dinsmoor, M. ; Senka, J. ; Paychek, K. ; Peaceman, A. ; Moss, J. ; Salazar, A. ; Acosta, A. ; Hankins, G. ; Hauff, N. ; Palmer, L. ; Lockhart, P. ; Driscoll, D. ; Wynn, L. ; Sudz, C. ; Dengate, D. ; Girard, C. ; Field, S. ; Breault, P. ; Smith, F. ; Annunziata, N. ; Allard, D. ; Silva, J. ; Gamage, M. ; Hunt, J. ; Tillinghast, J. ; Corcoran, N. ; Jimenez, M. ; Ortiz, F. ; Givens, P. ; Rech, B. ; Moran, C. ; Hutchinson, M. ; Spears, Z. ; Carreno, C. ; Heaps, B. ; Zamora, G. ; Seguin, J. ; Rincon, M. ; Snyder, J. ; Farrar, C. ; Lairson, E. ; Bonino, C. ; Smith, W. ; Beach, K. ; Van Dyke, S. ; Butcher, S. ; Thom, E. ; Zhao, Y. ; McGee, P. ; Momirova, V. ; Palugod, R. ; Reamer, B. ; Larsen, M. ; Spangler, T. ; Bhandaru, V. ; Vandorsten, J. P. / Serious maternal complications after early preterm delivery (24-33 weeks' gestation). In: American journal of obstetrics and gynecology. 2015 ; Vol. 213, No. 4. pp. 538.e1-538.e9.
@article{4d65a96ec05741a0a84176e54bbfe5a5,
title = "Serious maternal complications after early preterm delivery (24-33 weeks' gestation)",
abstract = "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. 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. 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). 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.",
keywords = "classic cesarean delivery, early preterm delivery, hemorrhage, infection, intensive care unit admission, maternal morbidity",
author = "Reddy, {Uma M.} and Rice, {Madeline Murguia} and Grobman, {William A.} and Bailit, {Jennifer L.} and Wapner, {Ronald J.} and Varner, {Michael W.} and Thorp, {John M.} and Leveno, {Kenneth J.} and Caritis, {Steve N.} and Mona Prasad and Tita, {Alan T N} and Saade, {George R.} and Yoram Sorokin and Rouse, {Dwight J.} and Blackwell, {Sean C.} and Tolosa, {Jorge E.} and C. Spong and S. Tolivaisa and M. Talucci and M. Zylfijaj and Z. Reid and R. Leed and J. Benson and S. Forester and C. Kitto and S. Davis and M. Falk and C. Perez and K. Hill and A. Sowles and J. Postma and S. Alexander and G. Andersen and V. Scott and V. Morby and K. Jolley and J. Miller and B. Berg and K. Dorman and J. Mitchell and E. Kaluta and K. Clark and K. Spicer and S. Timlin and K. Wilson and L. Moseley and M. Santillan and J. Price and K. Buentipo and V. Bludau and T. Thomas and L. Fay and C. Melton and J. Kingsbery and R. Benezue and H. Simhan and M. Bickus and D. Fischer and T. Kamon and D. Deangelis and B. Mercer and C. Milluzzi and W. Dalton and T. Dotson and P. McDonald and C. Brezine and A. McGrail and C. Latimer and L. Guzzo and F. Johnson and L. Gerwig and S. Fyffe and D. Loux and S. Frantz and D. Cline and S. Wylie and J. Iams and M. Wallace and A. Northen and J. Grant and C. Colquitt and D. Rouse and W. Andrews and G. Mallett and M. Ramos-Brinson and A. Roy and L. Stein and P. Campbell and C. Collins and N. Jackson and M. Dinsmoor and J. Senka and K. Paychek and A. Peaceman and J. Moss and A. Salazar and A. Acosta and G. Hankins and N. Hauff and L. Palmer and P. Lockhart and D. Driscoll and L. Wynn and C. Sudz and D. Dengate and C. Girard and S. Field and P. Breault and F. Smith and N. Annunziata and D. Allard and J. Silva and M. Gamage and J. Hunt and J. Tillinghast and N. Corcoran and M. Jimenez and F. Ortiz and P. Givens and B. Rech and C. Moran and M. Hutchinson and Z. Spears and C. Carreno and B. Heaps and G. Zamora and J. Seguin and M. Rincon and J. Snyder and C. Farrar and E. Lairson and C. Bonino and W. Smith and K. Beach and {Van Dyke}, S. and S. Butcher and E. Thom and Y. Zhao and P. McGee and V. Momirova and R. Palugod and B. Reamer and M. Larsen and T. Spangler and V. Bhandaru and Vandorsten, {J. P.}",
year = "2015",
month = "10",
day = "1",
doi = "10.1016/j.ajog.2015.06.064",
language = "English (US)",
volume = "213",
pages = "538.e1--538.e9",
journal = "American Journal of Obstetrics and Gynecology",
issn = "0002-9378",
publisher = "Mosby Inc.",
number = "4",

}

Reddy, UM, Rice, MM, Grobman, WA, Bailit, JL, Wapner, RJ, Varner, MW, Thorp, JM, Leveno, KJ, Caritis, SN, Prasad, M, Tita, ATN, Saade, GR, Sorokin, Y, Rouse, DJ, Blackwell, SC, Tolosa, JE, Spong, C, Tolivaisa, S, Talucci, M, Zylfijaj, M, Reid, Z, Leed, R, Benson, J, Forester, S, Kitto, C, Davis, S, Falk, M, Perez, C, Hill, K, Sowles, A, Postma, J, Alexander, S, Andersen, G, Scott, V, Morby, V, Jolley, K, Miller, J, Berg, B, Dorman, K, Mitchell, J, Kaluta, E, Clark, K, Spicer, K, Timlin, S, Wilson, K, Moseley, L, Santillan, M, Price, J, Buentipo, K, Bludau, V, Thomas, T, Fay, L, Melton, C, Kingsbery, J, Benezue, R, Simhan, H, Bickus, M, Fischer, D, Kamon, T, Deangelis, D, Mercer, B, Milluzzi, C, Dalton, W, Dotson, T, McDonald, P, Brezine, C, McGrail, A, Latimer, C, Guzzo, L, Johnson, F, Gerwig, L, Fyffe, S, Loux, D, Frantz, S, Cline, D, Wylie, S, Iams, J, Wallace, M, Northen, A, Grant, J, Colquitt, C, Rouse, D, Andrews, W, Mallett, G, Ramos-Brinson, M, Roy, A, Stein, L, Campbell, P, Collins, C, Jackson, N, Dinsmoor, M, Senka, J, Paychek, K, Peaceman, A, Moss, J, Salazar, A, Acosta, A, Hankins, G, Hauff, N, Palmer, L, Lockhart, P, Driscoll, D, Wynn, L, Sudz, C, Dengate, D, Girard, C, Field, S, Breault, P, Smith, F, Annunziata, N, Allard, D, Silva, J, Gamage, M, Hunt, J, Tillinghast, J, Corcoran, N, Jimenez, M, Ortiz, F, Givens, P, Rech, B, Moran, C, Hutchinson, M, Spears, Z, Carreno, C, Heaps, B, Zamora, G, Seguin, J, Rincon, M, Snyder, J, Farrar, C, Lairson, E, Bonino, C, Smith, W, Beach, K, Van Dyke, S, Butcher, S, Thom, E, Zhao, Y, McGee, P, Momirova, V, Palugod, R, Reamer, B, Larsen, M, Spangler, T, Bhandaru, V & Vandorsten, JP 2015, 'Serious maternal complications after early preterm delivery (24-33 weeks' gestation)', American journal of obstetrics and gynecology, vol. 213, no. 4, pp. 538.e1-538.e9. https://doi.org/10.1016/j.ajog.2015.06.064

Serious maternal complications after early preterm delivery (24-33 weeks' gestation). / Reddy, Uma M.; Rice, Madeline Murguia; Grobman, William A.; Bailit, Jennifer L.; Wapner, Ronald J.; Varner, Michael W.; Thorp, John M.; 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.; Spong, C.; Tolivaisa, S.; Talucci, M.; Zylfijaj, M.; Reid, Z.; Leed, R.; Benson, J.; Forester, S.; Kitto, C.; Davis, S.; Falk, M.; Perez, C.; Hill, K.; Sowles, A.; Postma, J.; Alexander, S.; Andersen, G.; Scott, V.; Morby, V.; Jolley, K.; Miller, J.; Berg, B.; Dorman, K.; Mitchell, J.; Kaluta, E.; Clark, K.; Spicer, K.; Timlin, S.; Wilson, K.; Moseley, L.; Santillan, M.; Price, J.; Buentipo, K.; Bludau, V.; Thomas, T.; Fay, L.; Melton, C.; Kingsbery, J.; Benezue, R.; Simhan, H.; Bickus, M.; Fischer, D.; Kamon, T.; Deangelis, D.; Mercer, B.; Milluzzi, C.; Dalton, W.; Dotson, T.; McDonald, P.; Brezine, C.; McGrail, A.; Latimer, C.; Guzzo, L.; Johnson, F.; Gerwig, L.; Fyffe, S.; Loux, D.; Frantz, S.; Cline, D.; Wylie, S.; Iams, J.; Wallace, M.; Northen, A.; Grant, J.; Colquitt, C.; Rouse, D.; Andrews, W.; Mallett, G.; Ramos-Brinson, M.; Roy, A.; Stein, L.; Campbell, P.; Collins, C.; Jackson, N.; Dinsmoor, M.; Senka, J.; Paychek, K.; Peaceman, A.; Moss, J.; Salazar, A.; Acosta, A.; Hankins, G.; Hauff, N.; Palmer, L.; Lockhart, P.; Driscoll, D.; Wynn, L.; Sudz, C.; Dengate, D.; Girard, C.; Field, S.; Breault, P.; Smith, F.; Annunziata, N.; Allard, D.; Silva, J.; Gamage, M.; Hunt, J.; Tillinghast, J.; Corcoran, N.; Jimenez, M.; Ortiz, F.; Givens, P.; Rech, B.; Moran, C.; Hutchinson, M.; Spears, Z.; Carreno, C.; Heaps, B.; Zamora, G.; Seguin, J.; Rincon, M.; Snyder, J.; Farrar, C.; Lairson, E.; Bonino, C.; Smith, W.; Beach, K.; Van Dyke, S.; Butcher, S.; Thom, E.; Zhao, Y.; McGee, P.; Momirova, V.; Palugod, R.; Reamer, B.; Larsen, M.; Spangler, T.; Bhandaru, V.; Vandorsten, J. P.

In: American journal of obstetrics and gynecology, Vol. 213, No. 4, 01.10.2015, p. 538.e1-538.e9.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Serious maternal complications after early preterm delivery (24-33 weeks' gestation)

AU - Reddy, Uma M.

AU - Rice, Madeline Murguia

AU - Grobman, William A.

AU - Bailit, Jennifer L.

AU - Wapner, Ronald J.

AU - Varner, Michael W.

AU - Thorp, John M.

AU - Leveno, Kenneth J.

AU - Caritis, Steve N.

AU - Prasad, Mona

AU - Tita, Alan T N

AU - Saade, George R.

AU - Sorokin, Yoram

AU - Rouse, Dwight J.

AU - Blackwell, Sean C.

AU - Tolosa, Jorge E.

AU - Spong, C.

AU - Tolivaisa, S.

AU - Talucci, M.

AU - Zylfijaj, M.

AU - Reid, Z.

AU - Leed, R.

AU - Benson, J.

AU - Forester, S.

AU - Kitto, C.

AU - Davis, S.

AU - Falk, M.

AU - Perez, C.

AU - Hill, K.

AU - Sowles, A.

AU - Postma, J.

AU - Alexander, S.

AU - Andersen, G.

AU - Scott, V.

AU - Morby, V.

AU - Jolley, K.

AU - Miller, J.

AU - Berg, B.

AU - Dorman, K.

AU - Mitchell, J.

AU - Kaluta, E.

AU - Clark, K.

AU - Spicer, K.

AU - Timlin, S.

AU - Wilson, K.

AU - Moseley, L.

AU - Santillan, M.

AU - Price, J.

AU - Buentipo, K.

AU - Bludau, V.

AU - Thomas, T.

AU - Fay, L.

AU - Melton, C.

AU - Kingsbery, J.

AU - Benezue, R.

AU - Simhan, H.

AU - Bickus, M.

AU - Fischer, D.

AU - Kamon, T.

AU - Deangelis, D.

AU - Mercer, B.

AU - Milluzzi, C.

AU - Dalton, W.

AU - Dotson, T.

AU - McDonald, P.

AU - Brezine, C.

AU - McGrail, A.

AU - Latimer, C.

AU - Guzzo, L.

AU - Johnson, F.

AU - Gerwig, L.

AU - Fyffe, S.

AU - Loux, D.

AU - Frantz, S.

AU - Cline, D.

AU - Wylie, S.

AU - Iams, J.

AU - Wallace, M.

AU - Northen, A.

AU - Grant, J.

AU - Colquitt, C.

AU - Rouse, D.

AU - Andrews, W.

AU - Mallett, G.

AU - Ramos-Brinson, M.

AU - Roy, A.

AU - Stein, L.

AU - Campbell, P.

AU - Collins, C.

AU - Jackson, N.

AU - Dinsmoor, M.

AU - Senka, J.

AU - Paychek, K.

AU - Peaceman, A.

AU - Moss, J.

AU - Salazar, A.

AU - Acosta, A.

AU - Hankins, G.

AU - Hauff, N.

AU - Palmer, L.

AU - Lockhart, P.

AU - Driscoll, D.

AU - Wynn, L.

AU - Sudz, C.

AU - Dengate, D.

AU - Girard, C.

AU - Field, S.

AU - Breault, P.

AU - Smith, F.

AU - Annunziata, N.

AU - Allard, D.

AU - Silva, J.

AU - Gamage, M.

AU - Hunt, J.

AU - Tillinghast, J.

AU - Corcoran, N.

AU - Jimenez, M.

AU - Ortiz, F.

AU - Givens, P.

AU - Rech, B.

AU - Moran, C.

AU - Hutchinson, M.

AU - Spears, Z.

AU - Carreno, C.

AU - Heaps, B.

AU - Zamora, G.

AU - Seguin, J.

AU - Rincon, M.

AU - Snyder, J.

AU - Farrar, C.

AU - Lairson, E.

AU - Bonino, C.

AU - Smith, W.

AU - Beach, K.

AU - Van Dyke, S.

AU - Butcher, S.

AU - Thom, E.

AU - Zhao, Y.

AU - McGee, P.

AU - Momirova, V.

AU - Palugod, R.

AU - Reamer, B.

AU - Larsen, M.

AU - Spangler, T.

AU - Bhandaru, V.

AU - Vandorsten, J. P.

PY - 2015/10/1

Y1 - 2015/10/1

N2 - 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. 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. 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). 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.

AB - 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. 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. 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). 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.

KW - classic cesarean delivery

KW - early preterm delivery

KW - hemorrhage

KW - infection

KW - intensive care unit admission

KW - maternal morbidity

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U2 - 10.1016/j.ajog.2015.06.064

DO - 10.1016/j.ajog.2015.06.064

M3 - Article

VL - 213

SP - 538.e1-538.e9

JO - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

SN - 0002-9378

IS - 4

ER -