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

Sirgant, Delphine; Resseguier, Noémie; D’ercole, C.; Auquier, Pascal; Tosello, Barthélémy; Blanc, Julie

doi:10.1016/j.jogoh.2020.101764

Cited by 4 publications

(1 citation statement)

References 34 publications

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“…7,25 Furthermore, regardless of type, a deep myometrial incision is related to higher SMM. 26 The morphological changes in extracellular matrix materials in the uterine myometrium during pregnancy could also explain the morbidity of the surgical act of preterm cesarean, in which there is a high rate of collagen fibrils compared with elastic fibers. 27 The subgroup analyses showed that the association between gestational age under 26 weeks and SMM remained significant depending on the country of the study (European or non-European), whereas a wide variation in practices regarding the active antenatal care, including cesarean delivery, has been reported at periviable ages.…”

Section: Discussionmentioning

confidence: 99%

Severe maternal morbidity in preterm cesarean delivery: A systematic review and meta-analysis

Blanc

Resseguier

Loundou

et al. 2021

European Journal of Obstetrics & Gynecology and Reproductiv

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Section: Discussionmentioning

confidence: 99%

Severe maternal morbidity in preterm cesarean delivery: A systematic review and meta-analysis

Blanc

Resseguier

Loundou

et al. 2021

European Journal of Obstetrics & Gynecology and Reproductiv

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Maternal outcomes of cesarean delivery performed at early gestational ages: a systematic review and meta-analysis

Cerra

Morelli

Mascio

et al. 2021

American Journal of Obstetrics & Gynecology MFM

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This study aimed to report maternal outcomes of preterm (<34 weeks of gestation) cesarean delivery. DATA SOURCES: Medline, Embase, and ClinicalTrials.gov databases were searched electronically on September 1, 2020, utilizing combinations of the relevant medical subject heading terms, key words, and word variants for "cesarean delivery" and "outcome." STUDY ELIGIBILITY CRITERIA: We included only studies reporting maternal outcomes of cesarean delivery performed at <34 weeks of gestation. STUDY APPRAISAL AND SYNTHESIS METHODS: The primary outcome was a composite score of maternal surgical morbidity including maternal death, severe intrasurgical or postpartum hemorrhage, hysterectomy, need for blood transfusion, and damage to adjacent organs. Secondary outcomes were individual components of the primary outcome, need for reoperation, postsurgical infection, thromboembolism, and hysterectomy. We also performed 2 subgroup analyses considering cesarean delivery performed at <28 and <26 weeks of gestation. Meta-analyses of proportions using random effects model were used to combine data. RESULTS: A total of 15 studies involving 8378 women undergoing cesarean delivery at <34 weeks of gestation were included in the systematic review. Composite adverse maternal outcome was reported in 16.2% of women (95% confidence interval, 15.4−17.0) undergoing a cesarean delivery before 34 weeks of gestation. Hemorrhage, either intra-or postoperative, was observed in 6.9% of cases (95% confidence interval, 6.4−7.5), whereas 6.3% (95% confidence interval, 4.2−8.7) required blood transfusion. Damage to adjacent organs complicated the primary surgery in 2.0% of women (95% confidence interval, 0.1−6.4), whereas 1.2% (95% confidence interval, 0.3−3.4) required a reoperation after cesarean delivery. Maternal death occurred in 0.1% (95% confidence interval, 0.0−1.4). In women undergoing cesarean delivery at <28 weeks of gestation, composite adverse maternal outcome complicated 22.9% of cases (95% confidence interval, 16.7−33.8) and 14.0% (95% confidence interval, 5.8−24.9) experienced hemorrhage whereas 7.7% (95% confidence interval, 4.4−11.8) required blood transfusion. Finally, when considering women undergoing cesarean delivery at <26 weeks of gestation, composite adverse maternal outcome was reported in 24.8% (95% confidence interval, 10.1−43.4), whereas the corresponding figures for hemorrhage and need for blood transfusion were 9.2% (95% confidence interval, 1.7−21.6) and 6.1% (95% confidence interval, 0.3−10.0), respectively. CONCLUSION: Early cesarean delivery is affected by a high rate of maternal intra-and postoperative complications. The findings from systematic review can help clinicians in counseling parents when cesarean delivery is required in an early gestational age.

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The association between gestational age and maternal adverse outcomes in patients undergoing trial of labor after cesarean

Rasiah

Young

Raker

et al. 2024

Minerva Obstet Gynecol

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

Cited by 4 publications

References 34 publications

Severe maternal morbidity in preterm cesarean delivery: A systematic review and meta-analysis

Severe maternal morbidity in preterm cesarean delivery: A systematic review and meta-analysis

Maternal outcomes of cesarean delivery performed at early gestational ages: a systematic review and meta-analysis

The association between gestational age and maternal adverse outcomes in patients undergoing trial of labor after cesarean

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