Abstract
Objective The objective of our study was to compare the maternal and neonatal complications
of periviable birth by the delivery route.
Study Design A retrospective cohort study of periviable deliveries (220/7–256/7weeks) from 2013 to 2020 at a tertiary teaching institution was conducted. Deliveries
were grouped by the mode of delivery. Excluded deliveries included pregnancy termination,
anomaly, or undesired neonatal resuscitation. The primary composite maternal outcome
included death, intensive care admission, sepsis, surgical site infection, unplanned
operation, or readmission. Secondary outcomes included maternal blood loss, length
of stay, neonatal survival, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage
(IVH), necrotizing enterocolitis (NEC), patent ductus arteriosus (PDA), and retinopathy
of prematurity (ROP). Outcomes were compared using Student's t-test, Wilcoxon–Mann–Whitney and Chi-squared tests. Relative risk (RR) and 95% confidence
intervals were calculated with log-binomial regression. p-Values <0.05 were considered significant. Demographic and intervention variables
associated with the outcome and the exposure were included in an adjusted relative
risk (aRR) model. Subgroup analyses of singleton pregnancies and 220/7 to 236/7 weeks deliveries were conducted.
Results After exclusion, 230 deliveries were included in the cohort. Maternal characteristics
were similar between cohorts. For the primary outcome, cesarean delivery was associated
with a trend toward increased maternal morbidity (22.6 vs. 10.7%, RR = 2.11 [1.03–4.43],
aRR = 1.95 [0.94–4.03], p-value 0.07). Administration of magnesium sulfate, antenatal corticosteroids, and
tocolytics were similar between cohorts. Neonatal survival to discharge was not different
between the groups (54/83, 65.1% vs. 118/191, 61.8%, aRR = 0.93 [0.77–1.13]). Among
the 172 neonates discharged alive, there was no difference in BPD, IVH, NEC, PDA,
ROP, or intact survival.
Conclusion Periviable birth has a high rate of maternal morbidity with a trend toward the highest
risk among women undergoing cesarean delivery. These risks should be included in shared
decision-making.
Key Points
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Periviable birth has high maternal morbidity (19%) and is highest after cesarean delivery
(23%).
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Route of delivery does not impact neonatal survival or intact neonatal survival.
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Head entrapment is rare during vaginal breech delivery.
Keywords
periviable birth - mode of delivery - maternal morbidity - neonatal survival - cesarean
delivery - fetal head entrapment
