Perinatal and Maternal Outcomes by Indication for Delivery in the Second Trimester

Area of Science:

• Obstetrics and Gynecology
• Neonatology
• Perinatal Medicine

Background:

• Perinatal and maternal outcomes in preterm birth can vary based on the reason for delivery.
• Severe preeclampsia (PE-SF) and preterm premature rupture of membranes (PPROM) are common indications for second-trimester preterm delivery.

Purpose of the Study:

• To compare perinatal and maternal outcomes between second-trimester deliveries indicated for PE-SF versus PPROM.
• To identify specific risks associated with each delivery indication in early preterm birth.

Main Methods:

• Secondary analysis of an observational cohort study involving singleton and twin preterm deliveries before 35 weeks' gestation.
• Included were singletons without congenital anomalies delivered between 24 0/7 and 27 6/7 weeks' gestation due to PE-SF or PPROM.
• Primary outcome was a composite of perinatal morbidity or death; secondary outcomes included small-for-gestational-age (SGA) birth and maternal morbidity.

Main Results:

• Deliveries for PE-SF were more likely associated with higher BMI, prior hypertensive disorders, chronic hypertension, and cesarean birth.
• Composite perinatal morbidity or death did not significantly differ between PE-SF and PPROM groups.
• Fetal death was significantly higher in the PE-SF group (aOR 6.04), and neonates were more likely to be SGA (aOR 13.45).

Conclusions:

• Second-trimester preterm birth for PE-SF is associated with an increased risk of fetal death compared to birth for PPROM.
• Composite neonatal morbidity and maternal morbidity did not differ significantly between the two indications.
• Delivery indication plays a role in specific perinatal outcomes for early preterm births.