Maternal morbidity after early preterm delivery (23-28 weeks)

Abstract Background Previous research has focused mainly on neonatal outcomes associated with preterm and periviable delivery, but maternal outcomes in this setting are less well described. Objective The objective of this study was to determine if early preterm delivery results in an increase in maternal morbidity. Study Design This is a retrospective cohort study at a tertiary care center over a 5-year time period. Subjects were identified by review of neonatal intensive care unit admission logs. Women were included if they delivered between 23w0d to 28w6d and their neonate was admitted to the neonatal intensive care unit. The prevalence of maternal morbidities was assessed, including blood transfusion, maternal infection, placental abruption, postpartum depression or positive depression screen, hemorrhage, and prolonged maternal postpartum hospitalization. A composite outcome comprising blood transfusion, maternal infectious morbidity, placental abruption, and postpartum depression was developed. Outcomes were compared for women who delivered between 23w0d to 25w6d (early group) and 26w0d to 28w6d (late group). Multivariate logistic regression analysis was performed to evaluate contributors to the composite morbidity, controlling for confounding. Results 82 women met the inclusion criteria: 38 in the early group and 44 in the late group. Maternal demographics were similar between the groups. The early group was significantly more likely to experience composite maternal morbidity (60.5 vs 27.3%, p=0.004) and infection (42.1 vs 13.6%, p=0.006). Regression analysis determined that increasing gestational age at delivery was associated with lower rates of the composite morbidity (OR 0.6, 95% CI 0.41 to 0.83). Conclusion This data suggest maternal morbidity is higher with delivery at periviable gestational ages. Composite morbidity and maternal infection are more frequent in those delivering at less than 26 weeks. The management of women at risk for delivery at early gestational ages should include a discussion of increased maternal complications.