Intraoperative adverse events associated with extremely preterm cesarean deliveries

Abstract

These results should help obstetricians and women making decisions about cesarean deliveries at these extremely low gestational ages.

Lower gestational age is associated with severe maternal morbidity of preterm cesarean delivery

“…This is consistent with previous published results about the increased risk of intraoperative adverse events in the case of singleton pregnancy. 18 We did not find an independent association between SMM and notable maternal pathology, even if highly heterogeneous, or between SMM and the type of prematurity (spontaneous or induced). This is an additional concept to consider that the SMM of preterm caesarean delivery is related to the surgical act itself.…”

“…This composite endpoint was chosen as a synthesis of prior definitions of severe maternal morbidity in these clinical situations literature and depending on available data during the stay of the mother. 18,19,[21][22][23] The main studied factor was gestational age at caesarean delivery. As a sensitivity analysis, gestational age was also studied as a binary variable with the threshold of 26 and 28 weeks, the usual thresholds defining extreme and very high prematurity, respectively.…”

“…[14][15][16] Few studies have assessed the SMM of extremely preterm caesarean delivery as well as the association between gestational age and SMM. 17,18 We have recently reported a secondary analysis of a population-based cohort study, demonstrating that mothers undergoing a caesarean delivery before 26 weeks experienced more than a two-fold increase in the risk of SMM compared with those undergoing a caesarean delivery between 26 and 34 weeks. 19 The strength of this previous study was its specific prospective populationbased cohort design, with its main limitation being the evaluation of SMM (defined as the occurrence of severe postpartum hemorrhage defined by the use of a blood transfusion, intensive care unit admission, or death) using available maternal variables from this cohort of preterm infants.…”

Association between gestational age and severe maternal morbidity and mortality of preterm cesarean delivery: a population-based cohort study

“…11,[24][25][26] The strength of our study includes the specific prospective population-based cohort design, 4 contrary to under-powered retrospective studies. 27 The number of mothers who had preterm cesareans before 26 weeks ensured enough power to answer our initial hypothesis.…”

Is vaginal delivery of a fetus in breech presentation at an extremely preterm gestational age associated with an increased risk of neonatal death? A comparative study

“…A cesarean at this very early gestational age exposes the woman to a high risk of well-known complications [ 22 , 23 ] especially to a scar in the uterine body in most cases (88% of the cesareans in our study) and to an excess risk of maternal mortality [ 24 – 26 ]. Maternal morbidity is also substantial [ 6 , 26 – 28 ] with complications in the short term (postpartum hemorrhages and severe anemia, thromboembolic and infectious events) and the long term—for subsequent pregnancies (uterine rupture, preterm delivery, abnormalities of placentation). The balance between benefits and risks—high for both the fetus and the mother—must be evaluated and considered.…”