Maternal Complications Associated With Periviable Birth.

Area of Science:

• Maternal-Fetal Medicine
• Obstetrics and Gynecology
• Public Health Epidemiology

Background:

• Periviable births, occurring between 20-25 weeks of gestation, represent a critical obstetric challenge.
• Understanding the maternal complication rates associated with periviable delivery is crucial for clinical management and patient counseling.

Purpose of the Study:

• To quantify the incidence and identify the types of maternal complications linked to periviable births.
• To compare maternal complication rates in periviable births versus preterm and term deliveries.

Main Methods:

• A population-based retrospective cohort study analyzed live births in Ohio from 2006-2015.
• Maternal outcomes were compared between periviable (20-25 weeks), preterm (26-36 weeks), and term (>36 weeks) delivery groups.
• Multivariate logistic regression was used to assess the association between periviable birth and adverse maternal outcomes, including chorioamnionitis, blood transfusion, hysterectomy, unplanned operations, and intensive care unit (ICU) admission.

Main Results:

• Of 1,457,706 live births, 6,085 (0.4%) were periviable.
• The composite adverse maternal outcome rate was 17.2% in the periviable group.
• Periviable birth was associated with a significantly higher risk of composite adverse maternal outcomes (adjusted RR 5.8) and specific complications like hysterectomy (adjusted RR 7.8) and ICU admission (adjusted RR 9.6) compared to term births. Risks were highest for deliveries between 20-22 weeks.

Conclusions:

• Periviable birth is strongly associated with substantial maternal morbidity.
• Approximately 17.2% of women experiencing periviable delivery in this cohort faced significant adverse maternal outcomes.
• The risk of maternal complications escalates with earlier gestational age at delivery within the periviable period.