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Association between gestational age and severe maternal morbidity and mortality of preterm cesarean delivery: a population-based cohort study

  • Julie Blanc
    Correspondence
    Reprints: Julie Blanc, MD, Department of Obstetrics and Gynecology, Nord Hospital, APHM, chemin des Bourrely, 13015 Marseille, France.
    Affiliations
    Department of Obstetrics and Gynecology, Nord Hospital, APHM, Marseille, France
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  • Noémie Resseguier
    Affiliations
    EA 3279, Public Health, Chronic Diseases and Quality of Life, Research Unit, Aix-Marseille University, Marseille, France
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  • François Goffinet
    Affiliations
    INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Research Center for Epidemiology and BioStatistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France

    Maternité Port-Royal, University Paris-Descartes, DHU Risk in Pregnancy, Hôpitaux Universitaires Paris Centre, Assistance Publique−Hôpitaux de Paris, Paris, France
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  • Elsa Lorthe
    Affiliations
    INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Research Center for Epidemiology and BioStatistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France

    EPI Unit, Institute of Public Health, University of Porto, Porto, Portugal
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  • Gilles Kayem
    Affiliations
    INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Research Center for Epidemiology and BioStatistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France

    Department of Obstetrics and Gynecology, Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Université Pierre and Marie Curie Paris 06, Paris, France
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  • Pierre Delorme
    Affiliations
    INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Research Center for Epidemiology and BioStatistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France

    Maternité Port-Royal, University Paris-Descartes, DHU Risk in Pregnancy, Hôpitaux Universitaires Paris Centre, Assistance Publique−Hôpitaux de Paris, Paris, France
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  • Christophe Vayssière
    Affiliations
    Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France

    UMR 1027 INSERM, University of Paul Sabatier Toulouse III, Toulouse, France
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  • Pascal Auquier
    Affiliations
    EA 3279, Public Health, Chronic Diseases and Quality of Life, Research Unit, Aix-Marseille University, Marseille, France
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  • Claude D’Ercole
    Affiliations
    Department of Obstetrics and Gynecology, Nord Hospital, APHM, Marseille, France

    EA 3279, Public Health, Chronic Diseases and Quality of Life, Research Unit, Aix-Marseille University, Marseille, France
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Published:January 09, 2019DOI:https://doi.org/10.1016/j.ajog.2019.01.005

      Background

      Cesarean delivery rates at extreme prematurity have regularly increased over the past years, and few previous studies have investigated severe maternal morbidity associated with extreme preterm cesarean delivery.

      Objective

      The aim of this study was to evaluate whether gestational age <26 weeks of gestation (weeks) was associated with severe maternal morbidity and mortality (SMMM) of preterm cesarean deliveries in comparison with cesarean deliveries between 26 and 34 weeks.

      Materials and Methods

      The Etude Epidémiologique sur les petits âges gestationnels (EPIPAGE) 2 is a national prospective population-based cohort study of preterm births in 2011. We included mothers with cesarean deliveries between 22 and 34 weeks, excluding those who had a cesarean delivery for the second twin only and those with pregnancy terminations. SMMM was analyzed as a composite endpoint defined as the occurrence of at least 1 of the following complications: severe postpartum hemorrhage defined by the use of a blood transfusion, intensive care unit admission, or death. To assess the association of gestational age <26 weeks and SMMM, we used multivariate logistic regression and a propensity score−matching approach.

      Results

      Among 2525 women having preterm cesarean deliveries, 116 before 26 weeks and 2409 between 26 and 34 weeks, 407 (14.4%) presented with SMMM. The SMMM occurred in 31 mothers (26.7%) who were at gestational age <26 weeks vs 376 (14.2%) between 26 and 34 weeks (P < .001). Cluster multivariate logistic regression showed significant association of gestational age <26 weeks and SMMM (adjusted odds ratio [aOR], 2.50; 95% confidence interval [CI], 1.42–4.40) and propensity score−matching analysis was consistent with these results (aOR, 2.27; 95% CI, 1.31–3.93).

      Conclusion

      Obstetricians should know about the higher SMMM associated with cesarean deliveries before 26 weeks, integrate this knowledge into decisions regarding cesarean delivery, and be prepared to manage the associated complications.

      Key words

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