580: Maternal morbidity after early preterm delivery (23-28 weeks)

Abstract

To describe the differences in maternal morbidity following preterm birth by gestational age This is a retrospective cohort study of women who delivered at a tertiary care hospital between 1/2013 and 12/2017. Women were included if they delivered between 23w0d to 28w6d and the neonate was admitted to the neonatal intensive care unit. A composite maternal morbidity (blood transfusion, infection, placental abruption, postpartum depression diagnosed or screen positive) was compared for women who delivered between 23w0d to 25w6d (early) and 26w0d to 28w6d (late). T-test, Mann Whitney U or Fisher’s exact test were used where appropriate. During the study period, 82 women met the inclusion criteria. There were 38 women in the early group compared to 44 women in the late group. Maternal age, BMI, delivery type (vaginal vs cesarean), hypertensive disease, membrane status, smoking, drug use and multifetal gestations were similar between the groups. The early delivery group was significantly more likely to experience composite maternal morbidity (60.5% vs 29.5%, p=0.0072). The early group was also more likely to experience maternal infection (42.1% vs 15.9%, p=0.0131). While it is well-established that neonatal morbidity and mortality are increased with decreasing gestational age, our data suggest that maternal morbidity is higher with delivery at early gestational ages. Composite morbidity and maternal infection appear to be a particularly frequent complication in those delivering less than 26 weeks. Because maternal morbidity is an increasing burden with a national focus on reduction, the management of women at risk for imminent delivery at early gestational ages should include a discussion of increased maternal complications.