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American Journal of Obstetrics and Gynecology

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Serious maternal complications after early preterm delivery (24-33 weeks’ gestation) - 25/09/15

Doi : 10.1016/j.ajog.2015.06.064 
Uma M. Reddy, MD, MPH a, ⁎ , Madeline Murguia Rice, PhD b, William A. Grobman, MD, MBA c, Jennifer L. Bailit, MD, MPH d, Ronald J. Wapner, MD f, Michael W. Varner, MD g, John M. Thorp, MD h, Kenneth J. Leveno, MD i, Steve N. Caritis, MD l, Mona Prasad, DO, MPH e, Alan T.N. Tita, MD, PhD m, George R. Saade, MD j, Yoram Sorokin, MD n, Dwight J. Rouse, MD o, Sean C. Blackwell, MD k, Jorge E. Tolosa, MD, MSCE p
for the

Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network

C. Spong, S. Tolivaisa, M. Talucci, M. Zylfijaj, 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, MD

a Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 
b George Washington University Biostatistics Center, Washington, DC 
c Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 
d Department of Obstetrics and Gynecology, MetroHealth Medical Center–Case Western Reserve University, Cleveland, OH 
e Department of Obstetrics and Gynecology, Ohio State University College of Medicine, Columbus, OH 
f Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY 
g Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT 
h Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 
i Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX 
j Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX 
k Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston–Children’s Memorial Hermann Hospital, Houston, TX 
l Department of Obstetrics and Gynecology, University of Pittsburgh School of Medicine, Pittsburgh, PA 
m Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL 
n Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI 
o Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI 
p Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR 

∗Corresponding author: Uma M. Reddy, MD, MPH.

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.

Le texte complet de cet article est disponible en PDF.

Key words : classic cesarean delivery, early preterm delivery, hemorrhage, infection, intensive care unit admission, maternal morbidity


Plan


 The project described was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD21410, HD27869, HD27915, HD27917, HD34116, HD34208, HD36801, HD40500, HD40512, HD40544, HD40545, HD40560, HD40485, HD53097, HD53118) and the National Center for Research Resources (UL1 RR024989, 5UL1 RR025764).
 Comments and views of the authors do not necessarily represent views of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
 The authors report no conflict of interest.
 Cite this article as: Reddy UM, Rice MM, Grobman WA, et al. Serious maternal complications after early preterm delivery (24-33 weeks’ gestation). Am J Obstet Gynecol 2015;213:538.e1-9.


© 2015  Publié par Elsevier Masson SAS.
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Vol 213 - N° 4

P. 538.e1-538.e9 - octobre 2015 Retour au numéro
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