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Am J Perinatol 2021; 38(02): 099-104
DOI: 10.1055/s-0040-1713927
SMFM Fellowship Series Article

Maternal Outcomes of Ongoing Pregnancies Complicated by Fetal Life-Limiting Conditions

Talia Coney
1   Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
,
Rachel Russell
1   Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
,
Steven R. Leuthner
2   Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
,
Anna Palatnik 
1   Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
3   Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
› Author Affiliations Funding None.
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Abstract

Objective This study aimed to examine maternal outcomes of ongoing pregnancies complicated by fetal life-limiting conditions.

Study design This was a retrospective matched cohort study of women with a diagnosis of fetal life-limiting condition between 2010 and 2018 in a single academic center. Cases were matched to controls (women who had normal fetal anatomic survey) according to year of delivery, body mass index, and parity in a 1:4 ratio. Bivariable and multivariable analyses were performed to compare the prevalence of the primary composite outcome, which included any one of the following: preeclampsia, gestational diabetes, cesarean delivery, third and fourth degree laceration, postpartum hemorrhage, blood transfusion, endometritis or wound infection, maternal intensive care unit admission, hysterectomy and maternal death, between cases and controls.

Results During the study period, we found 101 cases that met inclusion criteria, matched to 404 controls. The rate of the composite maternal outcome did not differ between the two groups (39.6 vs. 38.9%, p = 0.948). For individual outcomes, women with diagnosis of fetal life-limiting condition had higher rates of blood transfusion (2.0 vs. 0%, p = 0.005) and longer length of the first stage of labor (median of 12 [6.8–22.0] hours vs. 6.6 [3.9–11.0] hours; p < 0.001). In a multivariable analysis, first stage of labor continued to be longer by an average of 6.48 hours among women with a diagnosis of fetal life-limiting condition compared with controls.

Conclusion After controlling for confounding factors, except a longer first stage of labor, women diagnosed with fetal life-limiting conditions who continued the pregnancy did not have a higher rate of adverse maternal outcomes.

Key Points

  • The rates of ongoing pregnancies with fetal life-limiting conditions are increasing.

  • Women with ongoing pregnancies with fetal life-limiting conditions had longer first stage of labor.

  • The rest of the adverse maternal outcomes were not increased in this obstetric population.

Keywords

fetal life-limiting condition - palliative care plan - ongoing pregnancy - obstetric outcomes

Note

This study was presented in the poster format at the 40th annual meeting of the Society for Maternal–Fetal Medicine, Grapevine, TX, February 5 to 8, 2020.




Publication History

Received: 29 March 2020

Accepted: 02 June 2020

Article published online:
09 July 2020

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