Preterm delivery for maternal or fetal indications: maternal morbidity, neonatal outcome and late sequelae in infants

Objective To assess maternal morbidity, and neonatal outcome and especially long term sequelae in infants born preterm due to maternal or fetal indica tions. Design Analysis of retrospective cohort. Setting Oulu University Central Hospital, Finland. Population One hundred and three women, who were between the 24th and the 3 3rd week of pregnancy, delivered by caesarean delivery because of maternal or fetal indications. They were matched with 103 women who had spontaneous preterm delivery at corresponding gestational weeks between 1990-1997. Main outcome measures Maternal morbidity, reasons for caesarean delivery, n eonatal mortality and morbidity rates, and later development of the infants . Results Pre-eclampsia was diagnosed in 57% of the women in the indicated gr oup and only in one woman in the control group. All infants in the indicate d group and almost a third in the control group were born by caesarean birt h; the main indication was threatening fetal asphyxia. There was a signific ant difference in neonatal mortality rates between the groups (175 vs 78 pe r thousand live births in the indicated vs control infants; RR 2.3, 95% CI 1.02, 4.9) and the main cause of death was respiratory insufficiency: 64% i n the indicated group and 22% in the controls; RR 2.9, 95% CI 0.8, 10. Resp iratory distress syndrome occurred more often (73% vs 53%, RR 1.4, 95% CI 1 .1, 1.7) and it was more severe and more complicated in infants in the indi cated group, compared with those in the control group. Symptomatic chronic lung disease at one year of age was more common in infants in the indicated group than in the control group (15% vs 3%; RR 4.6, 95% CI 1.4, 15.9). Conclusions Not only the risks of neonatal mortality and morbidity but also long term pulmonary consequences, appear to be greater in infants born pre term by indicated delivery than in preterm infants born spontaneously at co rresponding weeks.