title: Serious maternal complications after early preterm delivery (24-33 weeks' gestation).
abstract: 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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD. Electronic address: reddyu@mail.nih.gov.
authors.forename: Uma M
authors.initials: UM
authors.lastname: Reddy
authors.affiliation: George Washington University Biostatistics Center, Washington, DC.
authors.forename: Madeline Murguia
authors.initials: MM
authors.lastname: Rice
authors.affiliation: Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: William A
authors.initials: WA
authors.lastname: Grobman
authors.affiliation: Department of Obstetrics and Gynecology, MetroHealth Medical Center-Case Western Reserve University, Cleveland, OH.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Bailit
authors.affiliation: Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Wapner
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Varner
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: John M
authors.initials: JM
authors.lastname: Thorp
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Leveno
authors.affiliation: Department of Obstetrics and Gynecology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Steve N
authors.initials: SN
authors.lastname: Caritis
authors.affiliation: Department of Obstetrics and Gynecology, Ohio State University College of Medicine, Columbus, OH.
authors.forename: Mona
authors.initials: M
authors.lastname: Prasad
authors.affiliation: Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors.forename: Alan T N
authors.initials: AT
authors.lastname: Tita
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX.
authors.forename: George R
authors.initials: GR
authors.lastname: Saade
authors.affiliation: Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Sorokin
authors.affiliation: Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI.
authors.forename: Dwight J
authors.initials: DJ
authors.lastname: Rouse
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, TX.
authors.forename: Sean C
authors.initials: SC
authors.lastname: Blackwell
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Tolosa
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000379:methods*; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods; D004716:Endometritis / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008428:Maternal Mortality; D011183:Postoperative Complications / Q000453:epidemiology*; D006473:Postpartum Hemorrhage / Q000453:epidemiology* / Q000601:surgery; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D047928:Premature Birth; D012189:Retrospective Studies; D012306:Risk; D013529:Surgical Wound Dehiscence / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: classic cesarean delivery; early preterm delivery; hemorrhage; infection; intensive care unit admission; maternal morbidity