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Maternal Complications Associated With Periviable Birth

Rossi, Robert M., MD; DeFranco, Emily A., DO, MS

doi: 10.1097/AOG.0000000000002690
Contents: Preterm Birth: Original Research

OBJECTIVE: To quantify the rate of maternal complications associated with a periviable birth in a contemporary population of live births in the state of Ohio.

METHODS: We conducted a population-based retrospective cohort study of all live births in Ohio (2006–2015). Maternal, obstetric, and neonatal characteristics were compared between women who delivered in the periviable period (20–25 weeks of gestation) with those who delivered preterm (26–36 weeks of gestation) and at term (greater than 36 weeks of gestation). Women were also stratified by 3-week gestational age epochs (ie, 20–22, 23–25 weeks of gestation). The primary study outcome was a composite of individual adverse maternal outcomes (chorioamnionitis, blood product transfusion, hysterectomy, unplanned operation, and intensive care unit [ICU] admission). Multivariate logistic regression estimated the relative association of periviable birth with maternal complications.

RESULTS: Of 1,457,706 live births in Ohio during the 10-year study period, 6,085 live births (0.4%) occurred during the periviable period (20–25 weeks of gestation). The overall rate of the composite adverse outcome was 17.2%. In multivariate analysis, periviable birth was associated 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. Delivery between 20–22 weeks and 23–25 weeks of gestation was associated with the highest risk of composite adverse outcome. The risk of composite adverse outcome decreased with advancing gestational age stratum.

CONCLUSION: Periviable birth is associated with significant maternal morbidity. Nearly one in five women in this cohort had a serious morbidity associated with their periviable delivery.

Periviable birth is associated with increased risk of maternal complications.

Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio.

Corresponding author: Robert M. Rossi, MD, Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Medical Sciences Building, Room 4555, 231 Albert Sabin Way, Cincinnati, OH 45267-0526; email:

Supported by the Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, March of Dimes Grant 22-FY14-470.

Financial Disclosure Dr. DeFranco has received grants from Perinatal Institute, Cincinnati Children's Hospital Medical Center March of Dimes Grant 22-FY14-470 during the conduct of the study. The other author did not report any potential conflicts of interest.

Presented as a poster at the 84th Annual Meeting of the Central Association of Obstetricians and Gynecologists, October 18–21, 2017, Scottsdale, Arizona.

This study includes data provided by the Ohio Department of Health, which should not be considered an endorsement of this study or its conclusions.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received February 17, 2018. Received in revised form March 29, 2018. Accepted April 12, 2018.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.