Trends in obstetric management of extreme preterm birth at 23 to 27 weeks' gestation in a tertiary obstetric unit: A 10-year retrospective review.

OBJECTIVE

To evaluate maternal and perinatal outcomes in deliveries from 23 + 0 to 26 + 6 weeks gestation in a tertiary hospital.

STUDY DESIGN

A 10-year retrospective analysis was performed which included all women who delivered between 23 + 0 and 26 + 6 weeks gestation in a tertiary obstetric unit from 01/01/2007 to 31/12/2017 inclusive. Data were collected from electronic patient records and individual chart reviews using predetermined variables.

RESULTS

340 women and 402 infants were included. 84 % (282/340) were singleton pregnancy and 17 % (59/340) had multiple pregnancies. 36.8 % (125/340) of women were delivered by Caesarean section, 11.2 % (14/125) had a classical caesarean section. The leading indications for delivery were preterm premature ruptured membranes (PPROM) 28.2 % (96/340), 8.5 % (29/340) severe pre-eclampsia (PET) and 5.6 % (19/340) were delivered for suspected placental abruption. Of all infants (N = 402), 18.9 % (76/402) were stillborn. 300 infants were admitted to the Neonatal Intensive Care Unit (NICU). The NICU survival to discharge rate was 83.7 % (251/300). The overall perinatal mortality rate (PNMR) was 328.4/1000 and a further late neonatal mortality of 47.3/1000 births. Notably, at the 23 week gestation NNDs are the major contributor to the PNMR and at later gestations stillbirths are the largest contributor.

CONCLUSION

Pregnant women delivering at extreme preterm gestations are at risk of maternal morbidity. Their infants have high rates of serious morbidity and mortality, with all survivors in this cohort affected by neonatal morbidity. Informed decision-making by providers and parents requires evidence based information on perceived outcomes, ideally individualized to the mother and pregnancy in question. Information from this retrospective cohort study can be used to counsel women and their families on potential morbidity and mortality and to manage expectations.