Study of serious maternal complications after preterm delivery 28–36 weeks gestation
Journal Title: MedPulse -International Medical Journal - Year 2017, Vol 4, Issue 6
Abstract
Aims and Objective: To study the prevalence of serious maternal complications after preterm birth by delivery route and type of cesarean incision. Materials and Methods: We at DMCH included detailed information on patient characteristics, intrapartum events, and pregnancy outcomes. Patients eligible for data collection were those who delivered within the institution, were at least 28 weeks of gestation, had a live fetus on admission and delivered during the 24-hour period of randomly selected days. Serious mat ernal complications were defined as the occurrence of one of the following: hemorrhage (blood loss ≥1500 mL, blood transfusion, or hysterectomy for hemorrhage); infection (endometritis, wound dehiscence, or wound infection requiring antibiotics, reopening or unexpected procedure); ICU admission; or death. Study Design: Data from maternal and neonatal charts for all deliveries on randomly selected days in DMCH. All women delivering non-anomalous singletons between 28 and 36 week’s gestation were included. Women were excluded for antepartum stillbirth and highly morbid conditions for which route of delivery would not likely impact morbidity including non-reassuring fetal status, cord prolapse, placenta previa, placenta accreta, placental abruption, and severe, 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); ICU admission; or death. Delivery route was categorized as classical cesarean delivery (CCD), low transverse cesarean delivery (LTCD), low vertical cesarean delivery (LVCD), and vaginal delivery (VD). Association of delivery route with complications was estimated using multivariable regression models yielding adjusted relative risks (aRR). Results: Of 886 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 28-30 weeks of gestation. The frequency of complications was associated with delivery route; compared with 3.5% of SVD, 23.0% of CCD (aRR 3.54, 95%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). Conclusion: Preterm delivery is relatively more risky and troublesome than full term delivery. The outcome depends on factors like potential hemorrhage, infection and ICU admission for preterm births requiring cesarean delivery. The physician should always be alert regarding these conditions and subsequentialy be able to manage them.
Authors and Affiliations
Arunanchal Jha, Sudha Bharti
Keywords
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