Periviable Births: Association of maternal morbidity with indications for delivery

To potentially improve management of periviable pregnancies, additional data is needed regarding natural history and clinical outcomes. We described the relationship between the indications for periviable preterm birth (PTB; delivery between 22w0d and 25w6d) and adverse maternal outcomes. Our retrospective study consisted of all singleton, periviable PTB (22.0 to 25.6 weeks) at a Level-IV care, academic medical center that delivered from 01/2017 to 03/2022. People with fetal demise upon admission or who underwent perinatal hospice care were excluded. Individuals were divided into groups based on the diagnosis at admission: spontaneous (preterm labor, premature rupture of membranes or cervical insufficiency) versus medical (hypertensive disorder of pregnancy, fetal growth restriction, non-reassuring fetal status or abruption). A composite maternal outcome included endometritis, need for transfusion, postpartum dilation and curettage, any wound complication, intensive care unit admission, venous thromboembolism/pulmonary embolism or maternal death were compared between groups. Among the 204 periviable deliveries that met the inclusion criteria, 138 (68%) were identified as spontaneous labor and 66 (32%) as medically indicated. Table 1 compares the clinical characteristics between groups; people with spontaneous PTB were more likely to have transfer to our facility. Medically indicated PTB had higher rates of hypertensive disorders of pregnancy (p< 0.001), fetal growth restriction (p< 0.001) and cesarean delivery (p=0.004). There were no differences in the rates of maternal morbidity between groups (Table 2). We found no difference in latency period between spontaneous and medically indicated deliveries in the periviable period. Additionally, there was no difference in composite maternal adverse outcomes between the two groups.View Large Image Figure ViewerDownload Hi-res image Download (PPT)