TOPLINE

For births at 22 weeks 0 days to 25 weeks 6 days of gestation, cesarean delivery was associated with higher risks for multiple serious maternal complications than vaginal delivery.

METHODOLOGY

• Researchers conducted a cross-sectional analysis to assess trends, risk factors, and adverse maternal outcomes associated with cesarean delivery at periviable gestational ages.
• They included 98,240 singleton deliveries at 22 weeks 0 days to 25 weeks 6 days of gestation using data from a US inpatient sample from 2016 to 2022.
• Overall, 40.3% of deliveries were cesarean and 59.7% were vaginal. Median maternal ages were 29.9 and 28.2 years, respectively.
• The primary endpoint was the risk for eight adverse maternal outcomes, including nontransfusion severe maternal morbidity, transfusion, and critical care procedures, compared between cesarean and vaginal deliveries.

TAKEAWAY

• The rate of cesarean delivery for periviable births increased by an average of 1.6% per year over the study period.
• Cesarean delivery was associated with higher odds of nontransfusion severe maternal morbidity (adjusted odds ratio [aOR], 2.50; 95% CI, 2.10-2.97), transfusion (aOR, 2.44; 95% CI, 2.03-2.94), a composite of critical care (aOR, 3.41; 95% CI, 2.25-5.17), and venous thromboembolism (aOR, 2.44; 95% CI, 1.27-4.70) than vaginal delivery.
• Cesarean vs vaginal delivery for periviable births was also associated with significantly higher odds of wound infection, endometritis, and peripartum hysterectomy and lower odds of postpartum hemorrhage.
• Prior cesarean delivery and hypertensive disorders of pregnancy were associated with increased odds of cesarean delivery for periviable births.

IN PRACTICE

"Maternal risks and outcomes are an important consideration for patient counseling regarding mode of delivery for periviable birth, especially in cases where neonatal benefit of cesarean is uncertain," the authors wrote.

SOURCE

The study was led by Marie-Julie Trahan, MD, of Columbia University Irving Medical Center in New York City. It was published online on September 18 in JAMA Network Open.

LIMITATIONS

Researchers lacked clinical data on surgical technique, use of antibiotics, and prophylaxis of thromboembolism. They used diagnosis codes, which may have misclassified or missed diagnoses or gestational age. The study did not capture later health effects of periviable cesarean delivery.

DISCLOSURES

The authors did not report any specific funding source for the study. One author reported receiving equity from Delfina Care, Inc, outside of this work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.