title: Maternal complications in settings where two-thirds of extremely preterm births are delivered by cesarean section.
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.
  
  
  METHODS
  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.
authors: Susanne
authors: S
authors: Hesselman
authors: Maria
authors: M
authors: Jonsson
authors: Eva-Britta
authors: EB
authors: Råssjö
authors: Monika
authors: M
authors: Windling
authors: Ulf
authors: U
authors: Högberg
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D062071:Infant, Extremely Premature; D011247:Pregnancy; D047928:Premature Birth; D012189:Retrospective Studies