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Maternal and perinatal outcomes of pregnancies delivered at 23 weeks' gestation.

Crane, JM; Magee, LA; Lee, T; Synnes, A; von Dadelszen, P; Dahlgren, L; De Silva, DA; Liston, R; Canadian Perinatal Network (CPN) Collaborative Group, CPN (2015) Maternal and perinatal outcomes of pregnancies delivered at 23 weeks' gestation. Journal of Obstetrics and Gynaecology Canada, 37 (3). pp. 214-224. ISSN 1701-2163
SGUL Authors: von Dadelszen, Peter

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OBJECTIVE: To evaluate the maternal and perinatal outcomes of pregnancies delivered at 23+0 to 23+6 weeks' gestation. METHODS: This prospective cohort study included women in the Canadian Perinatal Network who were admitted to one of 16 Canadian tertiary perinatal units between August 1, 2005, and March 31, 2011, and who delivered at 23+0 to 23+6 weeks' gestation. Women were included in the network if they were admitted with spontaneous preterm labour with contractions, a short cervix without contractions, prolapsing membranes with membranes at or beyond the external os or a dilated cervix, preterm premature rupture of membranes, intrauterine growth restriction, gestational hypertension, or antepartum hemorrhage. Maternal outcomes included Caesarean section, placental abruption, and serious complication. Perinatal outcomes were mortality and serious morbidity. RESULTS: A total of 248 women and 287 infants were included in the study. The rate of Caesarean section was 10.5% (26/248) and 40.3% of women (100/248) had a serious complication, the most common being chorioamnionitis (38.6%), followed by blood transfusion (4.5%). Of infants with known outcomes, perinatal mortality was 89.9% (223/248) (stillbirth 23.3% [67/287] and neonatal death 62.9% [156/248]). Of live born neonates with known outcomes (n = 181), 38.1% (69/181) were admitted to NICU. Of those admitted to NICU, neonatal death occurred in 63.8% (44/69). Among survivors at discharge, the rate of severe brain injury was 44.0% (11/25), of retinopathy of prematurity 58.3% (14/24), and of any serious neonatal morbidity 100% (25/25). Two subgroup analyses were performed: in one, antepartum stillbirths were excluded, and in the other only centres that indicated they offered fetal monitoring at 23 weeks' gestation were included and antepartum stillbirths were excluded. In each of these, perinatal outcomes similar to the overall group were found. CONCLUSION: Pregnant women delivering at 23 weeks' gestation are at risk of morbidity. Their infants have high rates of serious morbidity and mortality. Further research is needed to identify strategies and forms of management that not only increase perinatal survival but also reduce morbidities in these extremely low gestational age infants and reduce maternal morbidity.

Item Type: Article
Additional Information: © 2015 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved. Made available with permission from the publisher. Contact publisher for any further re-use.
Keywords: extreme preterm birth, maternal, perinatal, periviable birth, Adult, Brain Diseases, Canada, Cesarean Section, Cohort Studies, Female, Gestational Age, Humans, Infant, Newborn, Infant, Premature, Infant, Premature, Diseases, Intensive Care, Neonatal, Morbidity, Perinatal Death, Perinatal Mortality, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Premature Birth, Prospective Studies, Retinopathy of Prematurity, Canadian Perinatal Network (CPN) Collaborative Group, Humans, Brain Diseases, Retinopathy of Prematurity, Pregnancy Complications, Premature Birth, Infant, Premature, Diseases, Pregnancy Outcome, Intensive Care, Neonatal, Cesarean Section, Morbidity, Cohort Studies, Prospective Studies, Gestational Age, Pregnancy, Adult, Infant, Newborn, Infant, Premature, Canada, Female, Perinatal Mortality, Perinatal Death, 1114 Paediatrics And Reproductive Medicine
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Journal of Obstetrics and Gynaecology Canada
ISSN: 1701-2163
Language: eng
1 March 2015Published
Publisher License: Publisher's own licence
PubMed ID: 26001868
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