Serious maternal complications after early preterm delivery (24-33 weeks' gestation)
| Autor: | Mercer Bm, S. Fyffe, K. Beach, B. Heaps, C. Brezine, J. P. Vandorsten, Valerija Momirova, J. Price, William A. Grobman, A. Sowles, J. Miller, C. Melton, Ashley Salazar, S. Tolivaisa, F. Smith, S. Van Dyke, R. Palugod, William W. Andrews, J. Benson, Yoram Sorokin, Felecia Ortiz, K. Wilson, S. Forester, J. Kingsbery, K. Spicer, Catherine Y. Spong, E. Kaluta, B. Reamer, M. Talucci, S. Frantz, E. Lairson, N. Hauff, C. Collins, Larry Stein, L. Guzzo, Uma M. Reddy, M. Zylfijaj, L. Wynn, Michele Falk, Martina Wallace, L. Palmer, J. Senka, K. Paychek, M. Ramos-Brinson, R. Benezue, V. Morby, K. Jolley, G. Zamora, Gary D.V. Hankins, Z. Reid, T. Thomas, M. Gamage, Karen F. Dorman, Jorge Sa Silva, B. Berg, M. Bickus, Kim Hill, M. Larsen, Y. Zhao, P. McDonald, Paula McGee, Madeline Murguia Rice, Shirley Alexander, Jorge E. Tolosa, T. Spangler, S. Davis, Ronald J. Wapner, Deborah A. Driscoll, D. Rouse, J. Hunt, Jennifer L. Bailit, D. Cline, W. Smith, Joan Moss, S. Field, T. Kamon, P. Givens, S. Timlin, George R. Saade, C. Bonino, C. Kitto, A. McGrail, S. Wylie, F. Johnson, C. Moran, Kenneth J. Leveno, J. Mitchell, C. Latimer, Jay D. Iams, A. Northen, V. Bludau, C. Perez, Hyagriv N. Simhan, A. Acosta, L. Moseley, A. Roy, J. Tillinghast, Monica Rincon, John M. Thorp, Donna Allard, Michael W. Varner, N. Corcoran, P. Breault, V. Scott, D. Loux, Steve N. Caritis, G. Andersen, C. Girard, Alan T.N. Tita, P. Campbell, K. Clark, J. Snyder, Mark K. Santillan, L. Fay, N. Jackson, V. Bhandaru, Z. Spears, Mara J. Dinsmoor, L. Gerwig, N. Annunziata, J. Postma, R. Leed, J. Seguin, C. Colquitt, Elizabeth Thom, Sean C. Blackwell, D. Deangelis, Carlos A. Carreno, T. Dotson, P. Lockhart, S. Butcher, D. Dengate, J. Grant, B. Rech, Alan M. Peaceman, M. Hutchinson, W. Dalton, G. Mallett, M. Jimenez, Dwight J. Rouse, Mona Prasad, Cynthia Milluzzi, C. Farrar, D. Fischer, K. Buentipo, C. Sudz |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Risk medicine.medical_specialty Placenta accreta Pregnancy Trimester Third Gestational Age Hysterectomy Article law.invention Cohort Studies Young Adult Postoperative Complications law Pregnancy Surgical Wound Dehiscence medicine Humans Surgical Wound Infection Blood Transfusion Retrospective Studies Placental abruption Vaginal delivery Obstetrics business.industry Cesarean Section Postpartum Hemorrhage Obstetrics and Gynecology Gestational age medicine.disease Delivery Obstetric Intensive care unit Placenta previa Anti-Bacterial Agents Intensive Care Units Maternal Mortality Pregnancy Trimester Second Gestation Premature Birth Female business Endometritis Premature rupture of membranes |
| Zdroj: | American journal of obstetrics and gynecology. 213(4) |
| ISSN: | 1097-6868 |
| Popis: | Objective We sought to describe the prevalence of serious maternal complications following early preterm birth by gestational age (GA), delivery route, and type of cesarean incision. Study Design Trained personnel abstracted data from maternal and neonatal charts for all deliveries on randomly selected days representing one third of deliveries across 25 US hospitals over 3 years (n = 115,502). All women delivering nonanomalous singletons between 23-33 weeks' gestation were included. Women were excluded for antepartum stillbirth and highly morbid conditions for which route of delivery would not likely impact morbidity including nonreassuring fetal status, cord prolapse, placenta previa, placenta accreta, placental abruption, and severe and unstable maternal conditions (cardiopulmonary collapse, acute respiratory distress syndrome, seizures). Serious maternal complications were defined as: hemorrhage (blood loss ≥1500 mL, blood transfusion, or hysterectomy for hemorrhage), infection (endometritis, wound dehiscence, or wound infection requiring antibiotics, reopening, or unexpected procedure), intensive care unit admission, or death. Delivery route was categorized as classic cesarean delivery (CCD), low transverse cesarean delivery (LTCD), low vertical cesarean delivery (LVCD), and vaginal delivery. Association of delivery route with complications was estimated using multivariable regression models yielding adjusted relative risks (aRR) controlling for maternal age, race, body mass index, hypertension, diabetes, preterm premature rupture of membranes, preterm labor, GA, and hospital of delivery. Results Of 2659 women who met criteria for inclusion in this analysis, 8.6% of women experienced serious maternal complications. Complications were associated with GA and were highest between 23-27 weeks of gestation. The frequency of complications was associated with delivery route; compared with 3.5% of vaginal delivery, 23.0% of CCD (aRR, 3.54; 95% confidence interval (CI), 2.29–5.48), 12.1% of LTCD (aRR, 2.59; 95% CI, 1.77–3.77), and 10.3% of LVCD (aRR, 2.27; 95% CI, 0.68–7.55) experienced complications. There was no significant difference in complication rates between CCD and LTCD (aRR, 1.37; 95% CI, 0.95–1.97) or between CCD and LVCD (aRR, 1.56; 95% CI, 0.48–5.07). Conclusion The risk of maternal complications after early preterm delivery is substantial, particularly in women who undergo cesarean delivery. Obstetricians need to be prepared to manage potential hemorrhage, infection, and intensive care unit admission for early preterm births requiring cesarean delivery. |
| Databáze: | OpenAIRE |
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