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Am J Perinatol 2022; 39(12): 1269-1278
DOI: 10.1055/a-1788-5802
SMFM Fellowship Series Article

The Impact of Mode of Delivery on Maternal and Neonatal Outcomes during Periviable Birth (22–25 Weeks)

Jared T. Roeckner 
1   Division of Maternal-Fetal Medicine, University of South Florida Morsani College of Medicine and Tampa General Hospital, Tampa, Florida
,
Erica Peterson
2   Division of Neonatology, University of South Florida Morsani College of Medicine, Tampa General Hospital, Tampa, Florida
,
Jennifer Rizzo
1   Division of Maternal-Fetal Medicine, University of South Florida Morsani College of Medicine and Tampa General Hospital, Tampa, Florida
,
Jaime Flores-Torres
2   Division of Neonatology, University of South Florida Morsani College of Medicine, Tampa General Hospital, Tampa, Florida
,
Anthony O. Odibo
3   Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
,
Jose R. Duncan
1   Division of Maternal-Fetal Medicine, University of South Florida Morsani College of Medicine and Tampa General Hospital, Tampa, Florida
› Author Affiliations Funding None.
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Abstract

Objective The objective of our study was to compare the maternal and neonatal complications of periviable birth by the delivery route.

Study Design A retrospective cohort study of periviable deliveries (220/7–256/7weeks) from 2013 to 2020 at a tertiary teaching institution was conducted. Deliveries were grouped by the mode of delivery. Excluded deliveries included pregnancy termination, anomaly, or undesired neonatal resuscitation. The primary composite maternal outcome included death, intensive care admission, sepsis, surgical site infection, unplanned operation, or readmission. Secondary outcomes included maternal blood loss, length of stay, neonatal survival, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), patent ductus arteriosus (PDA), and retinopathy of prematurity (ROP). Outcomes were compared using Student's t-test, Wilcoxon–Mann–Whitney and Chi-squared tests. Relative risk (RR) and 95% confidence intervals were calculated with log-binomial regression. p-Values <0.05 were considered significant. Demographic and intervention variables associated with the outcome and the exposure were included in an adjusted relative risk (aRR) model. Subgroup analyses of singleton pregnancies and 220/7 to 236/7 weeks deliveries were conducted.

Results After exclusion, 230 deliveries were included in the cohort. Maternal characteristics were similar between cohorts. For the primary outcome, cesarean delivery was associated with a trend toward increased maternal morbidity (22.6 vs. 10.7%, RR = 2.11 [1.03–4.43], aRR = 1.95 [0.94–4.03], p-value 0.07). Administration of magnesium sulfate, antenatal corticosteroids, and tocolytics were similar between cohorts. Neonatal survival to discharge was not different between the groups (54/83, 65.1% vs. 118/191, 61.8%, aRR = 0.93 [0.77–1.13]). Among the 172 neonates discharged alive, there was no difference in BPD, IVH, NEC, PDA, ROP, or intact survival.

Conclusion Periviable birth has a high rate of maternal morbidity with a trend toward the highest risk among women undergoing cesarean delivery. These risks should be included in shared decision-making.

Key Points

  • Periviable birth has high maternal morbidity (19%) and is highest after cesarean delivery (23%).

  • Route of delivery does not impact neonatal survival or intact neonatal survival.

  • Head entrapment is rare during vaginal breech delivery.

Keywords

periviable birth - mode of delivery - maternal morbidity - neonatal survival - cesarean delivery - fetal head entrapment

Authors' Contributions

All authors made substantial contributions to the conception and design of the work and to the acquisition, analysis, and interpretation of the data. The authors drafted and critically revised the work and approval of the final version submitted for publication.


Note

This work will be presented at the Society for Maternal-Fetal Medicine 42nd Annual Pregnancy Meeting, January 31 to February 5, 2022, in Orlando, FL.


Supplementary Material



Publication History

Received: 16 December 2021

Accepted: 22 February 2022

Accepted Manuscript online:
04 March 2022

Article published online:
31 May 2022

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