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

Blanc, Julie; Resseguier, Noémie; Loundou, Anderson; Boyer, Laurent; Auquier, Pascal; Tosello, Barthélémy; D’ercole, C.

doi:10.1016/j.ejogrb.2021.04.022

Cited by 10 publications

(8 citation statements)

References 34 publications

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“…Rates of C-section have increased across gestational ages 23–28 weeks. Observational data suggests delivery via C-section reduces the risk of mortality and IVH for extremely preterm infants [ 32 , 33 ] but the associated maternal morbidity should not be underestimated [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Resuscitation, survival and morbidity of extremely preterm infants in California 2011–2019

Higgins,

Baer,

Steurer

et al. 2023

J Perinatol

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Objective To describe changes over time in resuscitation, survival, and morbidity of extremely preterm infants in California. Study design This population-based, retrospective cohort study includes infants born ≤28 weeks. Linked birth certificates and hospital discharge records were used to evaluate active resuscitation, survival, and morbidity across two epochs (2011–2014, 2015–2019). Results Of liveborn infants, 0.6% were born ≤28 weeks. Active resuscitation increased from 16.9% of 22-week infants to 98.1% of 25-week infants and increased over time in 22-, 23-, and 25-week infants (p-value ≤ 0.01). Among resuscitated infants, survival to discharge increased from 33.2% at 22 weeks to 96.1% at 28 weeks. Survival without major morbidity improved over time for 28-week infants (p-value < 0.01). Conclusion Among infants ≤28 weeks, resuscitation and survival increased with gestational age and morbidity decreased. Over time, active resuscitation of periviable infants and morbidity-free survival of 28-week infants increased. These trends may inform counseling around extremely preterm birth.

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Section: Discussionmentioning

confidence: 99%

Resuscitation, survival and morbidity of extremely preterm infants in California 2011–2019

Higgins,

Baer,

Steurer

et al. 2023

J Perinatol

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“…Recent data suggest that the rate of cesarean delivery in the periviable period is increasing, to levels as high as 61% at 24 weeks' gestation [31]. Cesarean delivery at extremely early gestations is particularly hazardous for the mother [32][33][34]. Regardless of the uterine incision type, a periviable cesarean delivery results in an increased risk of uterine rupture in a subsequent pregnancy [35].Consistent with the principles of nonmaleficence and justice, a discussion of these risks should be included in the shared decision-making.…”

Section: Healthcare Justice Maternal Health Nicu Costs and Long-term ...mentioning

confidence: 99%

The Ethics and Practice of Periviability Care

Vidaeff,

Kaempf

2024

Children

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“…It is well known that preterm birth increases the risk of severe maternal morbidity. 19,20 Preterm delivery is associated with increased risks of hemorrhage, infection, intensive care unit admission, and death. 19 When analyzing the association between risk factors and adverse outcomes, adjustment for gestational age as a covariate will lead to bias.…”

Section: Research Implicationsmentioning

confidence: 99%

The Association between Fetal Growth Restriction and Maternal Morbidity

et al. 2023

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Objective This study aimed to compare adverse maternal outcomes between pregnancies complicated by fetal growth restriction (FGR) and those without FGR. Study Design This was a secondary analysis of the data from the Consortium on Safe Labor, which was conducted from 2002 to 2008 in 12 clinical centers with 19 hospitals across 9 American College of Obstetricians and Gynecologists districts. We included singleton pregnancies without any maternal comorbidities or placenta abnormalities. We compared the outcomes of individuals with FGR with individuals without FGR. Our primary outcome was severe maternal morbidity. Our secondary outcome included various adverse maternal and neonatal outcomes. Multivariable logistic regression was performed to obtain adjusted odds ratios (aOR) and 95% confidence intervals (95% CI), adjusting for confounders. Missing values for maternal age and body mass index were imputed. Results Of 199,611 individuals, 4,554 (2.3%) had FGR and 195,057 (97.7%) did not have FGR. Compared with the individuals without FGR, individuals with FGR had increased odds of severe maternal morbidity (0.6 vs. 1.3%; aOR: 1.97 [95% CI: 1.51–2.57]), cesarean delivery (27.7 vs. 41.2%; aOR: 2.31 [95% CI: 2.16–2.48]), pregnancy-associated hypertension (8.3 vs. 19.2%; aOR: 2.76 [95% CI: 2.55–2.99]), preeclampsia without severe features (3.2 vs. 4.7%; aOR: 1.45 [95% CI: 1.26–1.68]), preeclampsia with severe features (1.4 vs. 8.6%; aOR: 6.04 [95% CI: 5.39–6.76]), superimposed preeclampsia (18.3 vs. 30.2%; aOR: 1.99 [95% CI: 1.53–2.59]), neonatal intensive care unit admission (9.7 vs. 28.4%; aOR: 3.53 [95% CI: 3.28–3.8]), respiratory distress syndrome (2.2 vs. 7.7%; aOR: 3.57 [95% CI: 3.15–4.04]), transient tachypnea of the newborn (3.3 vs. 5.4%; aOR: 1.62 [95% CI: 1.40–1.87]), and neonatal sepsis (2.1 vs. 5.5%; aOR: 2.43 [95% CI: 2.10–2.80]). Conclusion FGR was associated with increased odds of severe maternal outcomes in addition to adverse neonatal outcomes. Key Points

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

Cited by 10 publications

References 34 publications

Resuscitation, survival and morbidity of extremely preterm infants in California 2011–2019

Resuscitation, survival and morbidity of extremely preterm infants in California 2011–2019

The Ethics and Practice of Periviability Care

The Association between Fetal Growth Restriction and Maternal Morbidity

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