Introduction: Observational studies show that periviable Caesarean sections (CS) may, in some cases, improve neonatal outcomes. However, few studies explore maternal health effects in current and future pregnancies. Our primary objective was to describe the characteristics of periviable CS, and the outcomes of subsequent deliveries in this cohort. Our secondary objective was to compare these outcomes to women who underwent vaginal delivery (SVD) for periviable birth.
Methods: We conducted a retrospective chart review, looking at women who delivered at a periviable gestation (23+0 – 25+6 weeks GA, index delivery) and went on to have least one subsequent delivery. Descriptive statistics, Chi-squared was used to examine characteristics of index CSs, index SVDs, and subsequent deliveries, and compare outcomes between the index CS and SVD groups.
Results: 129 births met criteria: 95 (73.6%) index SVDs, and 34 (26.4%) index CS. Of the index CS group, incisions were low transverse (64.7%), classical (14.7%), high transverse (8.8%), or inverted T (11.8%). CS indications were usually malpresentation (61.8%), or multiple gestations (17.6%). Maternal morbidity in the index delivery was not significantly different between the CS and SVD groups (26.5% vs. 17.9%, p=0.29). In subgroup analyses, morbidity rate did not significantly differ based on incision type (p=0.57).
The periviable and preterm birth rate in the first subsequent pregnancy was 47.1% in the index CS group, and 40% in the index SVD group (p=0.47). Maternal morbidity in the first subsequent delivery was 2.9% and 7.5% respectively (p=0.37). There was no incidence of transfusions, wound disruption, or infectious morbidity in either group.
Conclusion: When delivering at a tertiary academic centre, periviable CS do not show increased risk of adverse maternal outcomes in both index and subsequent deliveries compared with SVD.
Noor Ladhani– Maternal-Fetal Medicine specialist, Sunnybrook Health Sciences Centre, University of Toronto