501 Risk of fetal head entrapment at 22-25 weeks

Abstract

To determine the rate of fetal head entrapment in periviable infants (22w0d and 25w6d); to assess the differences in outcomes between vertex and non-vertex neonates delivering vaginally A retrospective cohort study of periviable deliveries (22w0d-25w6d) from 2013-19 at a single institution was conducted. After IRB approval, charts of vaginal deliveries of vertex and non-vertex neonates were reviewed to abstract maternal, obstetric, and neonatal information. Charts were excluded if neonatal resuscitation was not desired or offered. The primary outcome was the rate of fetal head entrapment at the time of vaginal delivery for non-vertex infants. Secondary outcomes for cephalic vs non-cephalic vaginal births included neonatal survival to discharge, a composite of neonatal morbidity and mortality (death, grades 3/4 IVH, chronic lung disease, and stage 3-5 ROP), and a composite of maternal morbidity (ICU admission, wound infection, unplanned operation, sepsis). Logistic regression was used to account for variation between cohorts. After exclusion, 71 vaginal deliveries of periviable neonates were included in the cohort (54 cephalic, 17 non-cephalic). Baseline maternal characteristics for the vertex and non-vertex cohorts are in Table 1. For the primary outcome, the rate of fetal head entrapment was 2/17 (11.8%). Survival to discharge was higher among cephalic infants (40/54 74.1% vs 7/17 41.2%, p-value 0.01, OR 0.2 95%CI 0.1-0.8). After adjustment for birthweight, there was no significant difference in survival to discharge between cohorts (aOR 0.4 95%CI 0.1-1.4). None of the neonates with head entrapment were discharged alive. When non-vertex IUFD deliveries were included in the cohort the rate of head entrapment decreased to 2/58 (3.4%). A composite of maternal morbidity, EBL, and LOS were similar between the groups. In this small cohort of non-vertex vaginal deliveries of neonates delivered from 22w0d-25w6d the risk of head entrapment was approximately 12% with similar neonatal and maternal outcomes. These risks should be included in shared decision making.View Large Image Figure ViewerDownload Hi-res image Download (PPT)