Periviable cesarean increases maternal complications

Periviable cesarean delivery was linked to higher maternal complication risk.
*Repeated cross-sectional database study; Level 4 (OCEBM).

Citation

Trahan MJ, Wen T, Huang Y, et al. Maternal Outcomes Among Periviable Births by Cesarean Delivery. JAMA Network Open. 2026;9(9):e2634705. doi:10.1001/jamanetworkopen.2026.34705

Background

Birth at 22 to 25 weeks creates difficult tradeoffs between possible newborn benefit and maternal surgical risk. Current guidance does not support cesarean delivery for periviability alone.

Patients

98,240 U.S. singleton delivery hospitalizations at 22 weeks 0 days to 25 weeks 6 days, 2016-2022. Excluded multifetal pregnancies, placenta accreta spectrum, vasa previa, and placenta previa.

Intervention

Cesarean delivery.

Control

Vaginal delivery.

Outcome

Maternal complications during delivery hospitalization, including severe morbidity without transfusion, transfusion, critical care, wound infection, blood clots, postpartum hemorrhage, endometritis, and hysterectomy.

Follow-up Period

Delivery hospitalization only.

Results

OutcomeRates: vaginal vs cesareanAdjusted odds ratioCrude number needed
Severe morbidity without transfusion2.8% vs 7.1%2.50 (95% CI 2.10 to 2.97)24 harmed
Transfusion2.3% vs 5.0%2.44 (95% CI 2.03 to 2.94)38 harmed
Critical care0.4% vs 1.4%3.41 (95% CI 2.25 to 5.17)100 harmed
Blood clots0.2% vs 0.5%2.44 (95% CI 1.27 to 4.70)334 harmed

Cesarean delivery rates rose over time: average annual percent change 1.6% (95% CI 0.7% to 2.4%). Results were adjusted for demographic, hospital, and clinical factors. This was not a randomized trial.

Limitations

Administrative codes may misclassify diagnoses and gestational age. The study lacked surgical details, newborn outcomes, later maternal outcomes, and cannot prove causation.

Funding

No funding reported; one author reported Delfina Care equity.

Clinical Application

Counsel periviable patients that cesarean may increase maternal harm; reserve decisions for individualized fetal benefit and maternal risk discussions.