213: Maternal characteristics associated with withholding interventions for births at 22-23 weeks of gestation

Abstract

To quantify the influence of maternal sociodemographic, medical and pregnancy characteristics on decisions to withhold antepartum and neonatal interventions with deliveries occurring at the threshold of viability, i.e.22-23 weeks of gestation. Case-control study of US live births at 22-23 weeks of gestation using vital statistics birth records from 2012-2016. We analyzed births that received no interventions in the treatment of periviable delivery. Births were defined as having no interventions if they did not receive maternal (cesarean delivery, maternal hospital transfer or antenatal corticosteroid administration) or neonatal interventions (NICU admission, surfactant administration, antibiotic administration or assisted ventilation). Logistic regression estimated the influence of maternal and pregnancy factors on the decision to decline interventions with delivery occurring at 22-23 weeks Of 19,844,580 US live births in 2012-16, 24,379 (0.12%) occurred at 22-23 weeks. Of 22 and 23 wk births, 56.3% and 15.7% respectively received no interventions (Fig. 1). In the adjusted model, factors associated with increased odds of withholding interventions included use of private insurance and singleton gestation. Having an appropriate fetal growth profile for gestational age, preeclampsia and chronic hypertension were associated with decreased odds of declining interventions (Table 1). Withholding maternal and neonatal interventions occurs frequently at the threshold of viability, especially at 22 weeks of gestation where the occurrence of not receiving maternal or neonatal interventions exceeds 50%. The disparity in withholding maternal and neonatal interventions between 22 and 23 wk births suggests that higher gestational age is a key predictor of utilizing interventions. Our data highlights various sociodemographic, pregnancy, and medical factors associated with the decision to decline interventions. This data elucidates observed practice patterns in the management of periviable births and may assist providers in the counseling of future at risk women and their families.View Large Image Figure ViewerDownload Hi-res image Download (PPT)