Maternal and Perinatal Outcomes of Pregnancies Delivered at 23 Weeks' Gestation. Issue 7 (July 2015)

• Record Type: Journal Article
• Authors: Crane, Joan M.G.; Magee, Laura A.; Lee, Tang; Synnes, Anne; von Dadelszen, Peter; Dahlgren, Leanne; De Silva, Dane A.; Liston, Robert
• Is Part Of: Obstetrical & gynecological survey. Volume 70:Issue 7(2015)
• Publication Date: 2015-07
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; Generative organs, Female -- Surgery -- Periodicals; 618
• DOI: 10.1097/01.ogx.0000469202.44985.9e
• Languages: English
• ISSNs: 0029-7828

Abstract

Abstract : ABSTRACT: In Canada, 7.9% of pregnancies deliver preterm, before 37 weeks' gestation, which can result in significant perinatal long- and short-term morbidity. Previous studies of perinatal outcomes of infants born at 23 weeks' gestation have not included stillborn or infants who died before neonatal intensive care unit (NICU) admission or considered populations with different ethnicities or health care access than the Canadian population. This study aims to evaluate the perinatal and maternal outcomes for pregnancies delivered at 23 weeks' gestation in tertiary care centers in Canada. Data were collected from the Canadian Perinatal Network (CPN), which includes women at 22 + 0 to 28 + 6 weeks' gestation admitted in 1 of 16 perinatal units in Canada from August 1, 2005, to March 31, 2011. Perinatal mortality and serious perinatal morbidity were the perinatal outcomes reported, and maternal outcomes reported included placental abruption, cesarean delivery, and other serious complications. Statistical analysis was performed for maternal characteristics, obstetric interventions, obstetric complications, and both perinatal and maternal outcomes. Two subgroup analyses excluded antepartum stillbirths, with one including only women and infants at centers offering fetal heart rate monitoring at 23 weeks. A total of 248 mothers and 287 infants from Western, Ontario/Quebec, and Atlantic centers were included in the study. For maternal outcomes, 10% of the group had cesarean deliveries, except in the subgroups. In centers offering fetal heart rate monitoring at 23 weeks, the cesarean delivery rate was 22%, excluding antepartum stillbirths. Forty percent of women had serious complications, with 38.6% experiencing chorioamnionitis and 4.5% having blood product transfusion. No maternal deaths were recorded in the study. Outcomes for 39 of 108 infants admitted to NICUs were not available because those units were not part of CPN. Of the 248 infants for whom outcomes are known, 156 had a neonatal death (62.9%), 112 (71.8%) of which occurred before NICU admission, 67 were stillborn (23.3%), and 25 (10.1%) survived. Of those survivors, all experienced serious neonatal morbidity, including retinopathy of prematurity (58.3%), neonatal sepsis (44.0%), severe brain injury (44.0%), and bronchopulmonary dysplasia (64.0%). While this study found a survival rate of 10.1% in all infants with known outcomes, previous studies have found a large range of survival rates, from 0% to 37% including stillbirths or 0% to 66% including only NICU admissions. These findings allow women to be more accurately informed about perinatal survival at 23 weeks' gestation. Further research should focus on strategies and management to increase survival and reduce infant and maternal morbidities in these extreme preterm births.