Rossi RM, et al. - In a contemporary population of live births in the state of Ohio, researchers investigated the rate of maternal complications associated with a periviable birth. They observed significant maternal morbidity in association with periviable birth. In this cohort, nearly one in five women reported a serious morbidity associated with their periviable delivery.

Methods

• A population-based retrospective cohort study including all live births in Ohio (2006–2015) was performed.
• Women who delivered in the periviable period (20–25 weeks of gestation) were compared with those who delivered preterm (26–36 weeks of gestation) and at term (greater than 36 weeks of gestation) regarding maternal, obstetric, and neonatal characteristics.
• Researchers also performed stratification of women by 3-week gestational age epochs (ie, 20–22, 23–25 weeks of gestation).
• They included a composite of individual adverse maternal outcomes (chorioamnionitis, blood product transfusion, hysterectomy, unplanned operation, and Intensive Care Unit [ICU] admission) as the primary study outcome.
• The relative association of periviable birth with maternal complications was assessed using multivariate logistic regression.

Results

• During the 10-year study period, researchers identified 1,457,706 live births in Ohio.
• Of these, 6,085 live births (0.4%) occurred during the periviable period (20–25 weeks of gestation).
• Outcomes revealed the overall rate of the composite adverse outcome of 17.2%.
• Multivariate analysis revealed a correlation of periviable birth with an increased risk of the composite adverse maternal outcome (adjusted relative risk [RR] 5.8, CI 5.4–6.2) and individual complications including transfusion (adjusted RR 4.4, CI 3.4–5.7), unplanned operative procedure (adjusted RR 2.0, CI 1.7–2.4), unplanned hysterectomy (adjusted RR 7.8, CI 4.6–13.0), uterine rupture (adjusted RR 7.1, CI 3.8–13.4), and ICU admission (adjusted RR 9.6, CI 7.2–12.7) compared with the term cohort.
• The highest risk of composite adverse outcome was evident in association with delivery between 20–22 weeks and 23–25 weeks of gestation.
• With advancing gestational age stratum, decrease in the risk of composite adverse outcome was noted.