Maternal complications in settings where two-thirds of extremely preterm births are delivered by cesarean section

Susanne Hesselman; Maria Jonsson; Eva-Britta Råssjö; Monika Windling; Ulf Högberg

doi:10.1515/jpm-2016-0198

Article

Maternal complications in settings where two-thirds of extremely preterm births are delivered by cesarean section

Susanne Hesselman , Maria Jonsson , Eva-Britta Råssjö , Monika Windling and Ulf Högberg

Published/Copyright: October 21, 2016

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From the journal Journal of Perinatal Medicine Volume 45 Issue 1

Abstract

Objective:

To investigate the maternal complications associated with cesarean section (CS) in the extremely preterm period according to the gestational week (GW) and to indication of delivery.

Study design:

This is a retrospective case-referent study with a review of medical records of women who delivered at 22–27 weeks of gestation (n=647) at two level III units in Sweden. For abdominal delivery, gestational length was stratified into 22–24 (n=105) and 25–27 (n=301) weeks. For comparison, data on women who underwent a CS at term were identified in a register-based database.

Results:

The rate of CS in extremely preterm births was 62.8%. There was no difference in the complication rates, but types of incisions other than the low transverse incision were required more often at 22–24 (18.1%) weeks than at 25–27 GWs (9.6%) (P=0.02). Major maternal complications occurred in 6.6% compared with 2.1% in the extremely preterm and term CS, respectively (P<0.01). A maternal indication of extremely preterm CS increased the risk of complications.

Conclusions:

Almost two-thirds of the births at 22–27 GWs had an abdominal delivery. No increase in short-term morbidity was observed at 22–24 weeks compared to 25–27 weeks. CS performed extremely preterm had more major complications recorded than cesarean at term. The complications are driven by the underlying maternal condition.

Keywords: Cesarean section; extremely preterm birth; post-operative complications; pregnancy complications

Funding: This work was supported by grants from the Center for Clinical Research in Dalarna and the Swedish Research Council. The funders had no involvement in the collection, analysis, and interpretation of the data or on the decision to submit the article for publication.

References

[1] Thomas PE, Petersen SG, Gibbons K. The influence of mode of birth on neonatal survival and maternal outcomes at extreme prematurity: a retrospective cohort study. Aust N Z J Obstet Gynaecol. 2016;56:60–8.10.1111/ajo.12404Search in Google Scholar PubMed

[2] Reddy UM, Rice MM, Grobman WA, Bailit JL, Wapner RJ, Varner MW, et al. Serious maternal complications after early preterm delivery (24-33 weeks’ gestation). Am J Obstet Gynecol. 2015;213:538.e1–9.10.1016/j.ajog.2015.06.064Search in Google Scholar PubMed PubMed Central

[3] Högberg U, Hakansson S, Serenius F, Holmgren PA. Extremely preterm cesarean delivery: a clinical study. Acta Obstet Gynecol Scand. 2006;85:1442–7.10.1080/00016340600969366Search in Google Scholar PubMed

[4] Hager RM, Daltveit AK, Hofoss D, Nilsen ST, Kolaas T, Øian P, et al. Complications of cesarean deliveries: rates and risk factors. Am J Obstet Gynecol. 2004;190:428–34.10.1016/j.ajog.2003.08.037Search in Google Scholar PubMed

[5] Pallasmaa N, Ekblad U, Aitokallio-Tallberg A, Uotila J, Raudaskoski T, Ulander VM, et al. Cesarean delivery in Finland: maternal complications and obstetric risk factors. Acta Obstet Gynecol Scand. 2010;89:896–902.10.3109/00016349.2010.487893Search in Google Scholar PubMed

[6] Mercer BM. Mode of delivery for periviable birth. Semin Perinatol. 2013;37:417–21.10.1053/j.semperi.2013.06.026Search in Google Scholar PubMed

[7] Herbst A, Kallen K. Influence of mode of delivery on neonatal mortality and morbidity in spontaneous preterm breech delivery. Eur J Obstet Gynecol Reprod Biol. 2007;133:25–9.10.1016/j.ejogrb.2006.07.049Search in Google Scholar PubMed

[8] Högberg U, Holmgren PA. Infant mortality of very preterm infants by mode of delivery, institutional policies and maternal diagnosis. Acta Obstet Gynecol Scand. 2007;86:693–700.10.1080/00016340701371306Search in Google Scholar PubMed

[9] Kallen K, Serenius F, Westgren M, Maršál K; EXPRESS Group.. Impact of obstetric factors on outcome of extremely preterm births in Sweden: prospective population-based observational study (EXPRESS). Acta Obstet Gynecol Scand. 2015;94:1203–14.10.1111/aogs.12726Search in Google Scholar PubMed

[10] Stoll BJ, Hansen NI, Bell EF, Walsh MC, Carlo WA, Shankaran S, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993–2012. J Am Med Assoc. 2015;314:1039–51.10.1001/jama.2015.10244Search in Google Scholar PubMed PubMed Central

[11] Fellman V, Hellstrom-Westas L, Norman M, Westgren M, Källén K, Lagercrantz H, et al. One-year survival of extremely preterm infants after active perinatal care in Sweden. J Am Med Assoc. 2009;301:2225–33.10.1097/01.aoa.0000367003.25266.35Search in Google Scholar

[12] Costeloe KL, Hennessy EM, Haider S, Stacey F, Marlow N, Draper ES. Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies). Br Med J. 2012;345:e7976.10.1136/bmj.e7976Search in Google Scholar

[13] Kollee LA, Cuttini M, Delmas D, Papiernik E, den Ouden AL, Agostino R, et al. Obstetric interventions for babies born before 28 weeks of gestation in Europe: results of the MOSAIC study. Br J Obstet Gynaecol. 2009;116:1481–91.10.1111/j.1471-0528.2009.02235.xSearch in Google Scholar

[14] Domellof M, Blomberg M, Engström E, Farooqi A, Hafström O, Herbst A, et al. Handläggning av hotande förtidsbörd och nyfödda barn vid gränsen för viabilitet (in Swedish). Swedish Society of Obstetrics and Gynecology. 2016. Available from: http://www.sfog.se.Search in Google Scholar

[15] Serenius F, Sjors G, Blennow M, Fellman V, Holmström G, Maršál K, et al. EXPRESS study shows significant regional differences in 1-year outcome of extremely preterm infants in Sweden. Acta Paediatr. 2014;103:27–37.10.1111/apa.12421Search in Google Scholar

[16] Center for Epidemiology. Evaluation of the Swedish Medical Birth Register. 2003;112:3.Search in Google Scholar

[17] Hesselman S, Hogberg U, Ekholm-Selling K, Rassjo EB, Jonsson M. The risk of uterine rupture is not increased with single- compared with double-layer closure: a Swedish cohort study. Br J Obstet Gynaecol. 2015;122:1535–41.10.1097/01.ogx.0000476287.54040.53Search in Google Scholar

[18] Dean AG, Sullivan KM, Soe MM. Open epi: open source epidemiologic statistics for public health. Available from: http://www.openepi.com. [updated 2015/05/04; cited 2015 2015/12/18].Search in Google Scholar

[19] Periviable Birth. Obstetric Care Consensus No. 3. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2015;126:e82–94.10.1097/AOG.0000000000001105Search in Google Scholar

[20] Boyle JG, Gabbe SG. T and J vertical extensions in low transverse cesarean births. Obstet Gynecol. 1996;87:238–43.10.1016/0029-7844(95)00388-6Search in Google Scholar

[21] Luthra G, Gawade P, Starikov R, Markenson G. Uterine incision-to-delivery interval and perinatal outcomes in transverse versus vertical incisions in preterm cesarean deliveries. J Matern Fetal Neonatal Med. 2013;26:1788–91.10.3109/14767058.2013.811226Search in Google Scholar PubMed

[22] Grant A, Glazener CM. Elective caesarean section versus expectant management for delivery of the small baby. Cochrane Database Syst Rev. 2001:CD000078.10.1002/14651858.CD000078Search in Google Scholar PubMed

[23] Chauhan SP, Magann EF, Wiggs CD, Barrilleaux PS, Martin JN, Jr. Pregnancy after classic cesarean delivery. Obstet Gynecol. 2002;100:946–50.10.1016/S0029-7844(02)02239-1Search in Google Scholar

[24] Lannon SM, Guthrie KA, Vanderhoeven JP, Gammill HS. Uterine rupture risk after periviable cesarean delivery. Obstet Gynecol. 2015;125:1095–100.10.1097/AOG.0000000000000832Search in Google Scholar PubMed PubMed Central

[25] Shipp TD, Zelop C, Cohen A, Repke JT, Lieberman E. Post-cesarean delivery fever and uterine rupture in a subsequent trial of labor. Obstet Gynecol. 2003;101:136–9.10.1097/00006250-200301000-00026Search in Google Scholar

[26] Kamara M, Henderson JJ, Doherty DA, Dickinson JE, Pennell CE. The risk of placenta accreta following primary elective caesarean delivery: a case-control study. Br J Obstet Gynaecol. 2013;120:879–86.10.1111/1471-0528.12148Search in Google Scholar PubMed

The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2016-6-5

Accepted: 2016-9-29

Published Online: 2016-10-21

Published in Print: 2017-1-1

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Articles in the same Issue

https://doi.org/10.1515/jpm-2016-0198

Keywords for this article

Cesarean section; extremely preterm birth; post-operative complications; pregnancy complications