Abstract
Delivery at extreme preterm gestational ages (GA) <;27 weeks is challenging with limited evidence often focused only on neonatal outcomes. We reviewed management and short term maternal, fetal and neonatal outcomes of births for 132 women (22 + 0 to 26 + 6 weeks’ GA) with a live fetus at admission to hospital and in labour or at planned emergency Caesarean section: 103 singleton and 29 (53 live fetuses) twin gestations. Thirty women (23%) had pre-existing medical problems, 110 (83%) had antenatal complications; only 17 (13%) women experienced neither. Major maternal labour and delivery complications affected 35 women (27%). 151 fetuses (97%) were exposed to antenatal steroids, 24 (15%) to tocolysis and 70 (45%) to magnesium sulphate. Delivery complications affected 11 fetuses, with 12 labour or delivery room deaths; survival to discharge was 75% (117/156), increasing with GA: 25% (1/4), 75% (18/24), 69% (29/42), 73% (33/45) and 88% (36/41) at 22, 23, 24, 25 and 26 weeks GA respectively (p = 0.024). No statistically important impact was seen from twin status, maternal illness or obstetric management. Even in a specialist perinatal unit antenatal and postnatal maternal complications are common in extreme preterm births, emphasising the need to include maternal as well as neonatal outcomes.
Highlights
Delivery at extreme preterm gestational ages (GA) < 27 weeks is challenging with limited evidence often focused only on neonatal outcomes
Parents need to receive accurate and targeted information from their expert multidisciplinary obstetric and neonatal team to allow them to reach consensus on the best way to provide care. To reduce both maternal and neonatal morbidity associated with birth at extreme preterm gestational ages it is crucial that obstetric management is optimised but the evidence to support counselling is lacking[4]
This study demonstrates the high prevalence of perinatal complications for both mothers and fetuses delivering between 22 and 26 completed weeks of gestation, despite management in a regional tertiary referral centre with a high throughput of these pregnancies
Summary
Delivery at extreme preterm gestational ages (GA) < 27 weeks is challenging with limited evidence often focused only on neonatal outcomes. Parents need to receive accurate and targeted information from their expert multidisciplinary obstetric and neonatal team to allow them to reach consensus on the best way to provide care To reduce both maternal and neonatal morbidity associated with birth at extreme preterm gestational ages it is crucial that obstetric management is optimised but the evidence to support counselling is lacking[4]. At these extreme gestations, delivery is not expedited until a signal of maternal or fetal compromise is noted, so as to provide time for the fetus to gain days or weeks in utero. 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Hôpital Tenon, Rue de la
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