Abstract
INTRODUCTION: Periviable birth accounts for only 0.5% of births but contributes to a majority of neonatal deaths. There is no clear recommendation regarding expediting delivery in periviable patients with advanced cervical dilation (ACD). The objective of this study was to assess whether expectant management versus expedited delivery in patients with ACD affects perinatal outcomes. METHODS: This is a single-institution retrospective cohort study of singleton gestations at 20.0–25.6 weeks with ACD (4–6 cm) on admission from 2016 to 2018. Individuals were stratified into two groups: 1) those who progressed spontaneously to delivery (expectant management) and 2) those who underwent augmentation of labor or cesarean delivery at the time of ACD diagnosis (expedited delivery). The primary outcome was neonatal mortality. Secondary outcomes included differences in postpartum hemorrhage and infection rates. RESULTS: Forty-three of 199 preterm deliveries met eligibility criteria: 21 were expectantly managed and 22 underwent expedited delivery. There was no difference in demographic characteristics or gestational age between the expectant management and expedited delivery groups (23′1 [SD 1.65] versus 24′4 [SD 3.05] weeks, [P=.9]). There was no difference in neonatal mortality (n=13 [61.9%] versus n=10 [45.5%], P=.3), maternal infection (n=1 [4.76%] versus n=4 [18.2%], P=.3) or postpartum hemorrhage (n=2 [9.5%] versus n=1 [4.5%], P=1.0) between the expectant management and expedited delivery groups, respectively. CONCLUSION: In this cohort, there were no differences in neonatal mortality, maternal infection, or postpartum hemorrhage between expectant management and expedited delivery in singletons with ACD in the periviable period. Larger studies are needed to inform guidelines for management of these complex cases.
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.