MATERNAL MORBIDITY AMONG PATIENTS WITH SEVERE OR LIFE-LIMITING FETAL CONDITIONS

Abstract

Objectives

To compare maternal morbidity with pregnancy continuation or abortion in pregnancies with severe or life-limiting fetal conditions.

Methods

We extracted data from a de-identified quality database of patients with fetal conditions who received care at our institution to compare maternal outcomes with pregnancy continuation and abortion. We included patients with fetal conditions which would significantly impact future quality of life, require serious intervention to sustain life, or be incompatible with life after delivery. We excluded multiple gestations, previable membrane rupture or fetal demise at time of diagnosis, concern for placenta accreta, and patients that delivered outside of our institution. We considered major morbidity as unplanned intra-abdominal surgery, intensive care unit admission, blood transfusion, venous thromboembolism, readmission within 6 weeks, sepsis, fourth-degree vaginal laceration, uterine rupture, and eclampsia. Minor morbidity included uterine infection requiring intravenous antibiotics, retained products requiring repeat procedure, shoulder dystocia, blood patch post-epidural, cervical lacerations, and third-degree vaginal lacerations.

Results

Overall, 387 and 423 individuals chose pregnancy continuation and abortion, respectively. Major morbidity occurred in 23(5.9%) and 7(1.7%), respectively (OR 3.76, 95% CI 1.59-8.85). Minor morbidity occurred in 32(8.3%) and 31(7.3%), respectively (OR 1.20, 95% CI 0.72-2.00). In the continuation group, documented fetal/neonatal demise occurred in 46(11.9%) and cesarean delivery occurred in 180(46.5%) patients. Major abdominal surgery (excluding cesarean delivery) occurred in 2(0.5%) and 2(0.5%), respectively. No mortality occurred in either group.

Conclusions

We observed increased maternal morbidity with pregnancy continuation compared to abortion in pregnancies with severe or life-limiting fetal conditions.