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Prematurity

Poster Session 4

(942) Periviable Outcomes stratified by Mode of Delivery

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Perviable birth, defined by ACOG as delivery at 20 0/7 - 25 6/7 weeks is associated with high maternal and neonatal morbidity.  Counseling regarding outcomes is typically based upon data from the Neonatal Outcome Trajectory Tool. We sought to obtain hospital specific data regarding outcomes stratified by mode of delivery (MOD) and gestational age (GA) to assist in counseling patients at risk of periviable birth.

Study Design: Retrospective cohort study of all livebirths from 22 0/7- 25/ 6/7 at a single tertiary academic medical center, 2012-2021. The objective was to assess infant outcomes with periviable birth stratified by MOD and GA.

Results:

There were 207 periviable liveborn infants delivered during the study period. 144 (70%) delivered via cesarean and 63 (30%) by vaginal delivery with 98 infants surviving to discharge. Mean GA at delivery was 24 0/7 ± 0.8 weeks. Infants born by cesarean were less likely to survive to discharge (39.6% vs 65.1%, p=0.001; aRR 0.49, 95% CI 0.19-1.23). Multivariable regression estimating association between cesarean and survival was performed, adjusting for HTN disorders, birthweight, and indication for delivery. There was no significant association between cesarean section and survival. There were similar neonatal ICU lengths of stay (164 vs 187 days, p=0.329) and rates of neonatal morbidities including BPD, high grade IVH, cerebral palsy, and retinopathy of prematurity between delivery cohorts, however the rate of necrotizing enterocolitis following cesarean was lower (7.0 vs 22.5%, p=0.036) compared to vaginal delivery, see Table 1. There was high but similar rate of tracheostomy (28.1% vs 30.0%, p=1.0) and gastrostomy tube (36.8% vs 23.7%, p=0.260) placement in neonates delivered by cesarean and vaginal route respectively.


Conclusion:

Within the study population, no statistically significant differences were observed for survival or postnatal complications between 22 0/7 and 25 6/7 weeks gestation based on MOD, other than a lower risk of necrotizing enterocolitis.