Association of Intended Mode of Delivery With Neonatal and Maternal Outcomes at 22–25 Weeks of Gestation

OBJECTIVE: To compare the risk of neonatal and maternal morbidity and mortality among individuals who delivered between 22 and 25 weeks of gestation by intended mode of delivery. METHODS: This was a secondary analysis of an observational cohort including participants with a singleton pregnancy delivered by planned cesarean delivery or after a trial of labor from 22 0/7 to 25 6/7 weeks of gestation. This analysis was limited to those who received both antenatal steroids and neonatal resuscitation. The primary outcome was a composite of neonatal death or severe neonatal morbidity. Secondary outcomes included neonatal mortality and measures of neonatal and maternal morbidity. Multivariable logistic regression analyses were used to adjust for prespecified covariates. RESULTS: Among 277 eligible individuals, 149 (53.8%) had a planned cesarean delivery, and 128 (46.2%) had a trial of labor, of whom 12 (9.4%) delivered by cesarean. The two groups were similar except for more frequent hypertensive disorders (47.7% vs 26.6%, P <.001) and lower median birth weight (620 g versus 660 g, P =.02) among those with planned cesarean delivery. There was no difference in the primary neonatal composite outcome (73.8% vs 79.7%, adjusted odds ratio [AOR] 0.68, 95% CI, 0.35–1.33) between groups or secondary neonatal outcomes. Planned cesarean delivery was associated with a higher frequency of maternal sepsis (6.0% vs 1.6%, AOR 8.28, 95% CI, 1.32–51.8) and postpartum readmission (8.1% vs 0.8%, AOR 12.0, 95% CI, 1.48–97.5) compared with trial of labor. Other adverse maternal outcomes were more frequent among planned cesarean deliveries but were not statistically significant. CONCLUSION: In this multisite registry, there was no difference in composite neonatal mortality or severe morbidity based on the intended mode of delivery, as well as no difference in secondary neonatal outcomes. Planned cesarean delivery was associated with increased maternal morbidity.