MFM Fellow The Ohio State University Columbus, OH, United States
Objective: To compare the risk of neonatal and maternal morbidity and mortality among individuals delivered between 22-25 weeks’ gestation by planned cesarean delivery (CD) or trial of labor (TOL).
Study Design: Secondary analysis of an observational cohort including participants with a singleton pregnancy delivered via planned CD or after a trial of labor (TOL) from 22w0d through 25w6d. This analysis was limited to those who received both antenatal steroids and neonatal resuscitation. The primary outcome was a composite of neonatal death or severe neonatal morbidity. Secondary outcomes included measures of neonatal and maternal morbidity. Multivariable logistic regression analyses were used to adjust for prespecified covariates. Planned interaction analyses were performed between planned mode of delivery and gestational age (GA) at delivery (22-23 weeks; 24-25 weeks), then within GA groups between planned mode of delivery and presentation.
Results: Among 277 eligible individuals, 149 (53.8%) had a planned CD and 128 (46.2%) had a TOL of which 12 (9.4%) delivered by CD (Table 1). The two groups were similar except for lower birthweight (622g vs. 663g, p=0.02) and more frequent hypertensive disorders (47.7% vs. 26.6%, p< 0.001) among those with planned CD. There was no difference in the primary neonatal composite outcome (73.8% vs. 79.7%, aOR 0.57, 95% CI 0.30-1.07) between groups. There were no differences in secondary neonatal outcomes except for higher frequency of intraventricular hemorrhage (IVH) in the TOL group (16.8% vs. 30.5%, aOR 0.50, 95% CI 0.28-0.90) (Table 1). Planned CD was associated with eight-fold greater odds of maternal sepsis and 12-fold greater odds of postpartum readmission; other outcomes were more frequent among planned CD but did not achieve statistical significance (Table 2). All interaction analyses were not significant.
Conclusion: In this multi-site registry, there was no difference in composite neonatal mortality or severe morbidity based on intended mode of delivery. Planned CD was associated with increased maternal morbidity but less risk of neonatal IVH.
