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Am J Perinatol
DOI: 10.1055/a-2800-3108
Original Article

Perinatal and Maternal Outcomes by Indication for Delivery in the Second Trimester

Authors

  • Kristen A. Cagino 

    1   Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas, United States

  • Paula L. McGee

    2   The George Washington University Biostatistics Center, Washington, District of Columbia, United States

  • Maged M. Costantine 

    3   Department of Maternal-Fetal Medicine, The Ohio State University, Columbus, Ohio, United States

  • Michael W. Varner 

    4   Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, United States

  • Alan T.N. Tita

    5   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, United States

  • Monica Longo

    6   Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, United States

  • Barbara J. Stoll

    7   Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, United States

  • John M. Thorp Jr.

    8   Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

  • Uma M. Reddy

    9   Department of Obstetrics and Gynecology, Columbia University, New York, New York, United States

  • William A. Grobman

    10   Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, United States

  • Dwight J. Rouse

    11   Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island, United States

  • Hyagriv N. Simhan

    12   Department of Ob/Gyn, University of Pittsburgh, Pittsburgh, Pennsylvania, United States

  • Jennifer L. Bailit

    13   Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, Ohio, United States

  • Lorraine Dugoff

    14   Department of Maternal-Fetal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States

  • George R. Saade

    15   Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas, United States

  • Baha M. Sibai

    1   Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas, United States
    • for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units Network, Bethesda, Maryland, United States

Funding Information This work is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant nos.: UG1 HD087230, UG1 HD027869, UG1 HD027915, UG1 HD034208, UG1 HD040500, UG1 HD040485, UG1 HD053097, UG1 HD040544, UG1 HD040545, UG1 HD040560, UG1 HD040512, UG1 HD087192, UG1 HD053109, UG1 HD027851, and U24 HD036801).
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Abstract

Objective

Perinatal and maternal morbidity in the setting of preterm birth may differ by delivery indication. We compared perinatal and maternal outcomes of second-trimester (240/7–276/7 weeks of gestation) deliveries indicated for preeclampsia with severe features (PE-SF), with those following preterm premature rupture of membranes (PPROM).

Study Design

Secondary analysis of an observational cohort study of singleton and twin preterm deliveries before 35 weeks' gestation at 33 hospitals across the United States. Singletons without congenital anomalies who were delivered due to PE-SF or PPROM from 240/7 to 276/7 weeks of gestation were included. The primary outcome was a composite of perinatal morbidity or death, defined as fetal or neonatal death, severe bronchopulmonary dysplasia (BPD) grade III, intraventricular hemorrhage (IVH) grade III to IV, necrotizing enterocolitis (NEC) stage IIA or greater, periventricular leukomalacia (PVL), retinopathy of prematurity (ROP) stage III to IV, or culture-proven sepsis. Secondary outcomes included components of the primary outcome, small-for-gestational-age (SGA) birth, and a composite of maternal morbidity. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated.

Results

Among the 7,515 in the original cohort, 164 deliveries for PE-SF and 119 deliveries following PPROM were included. Individuals with PE-SF were more likely to have a BMI of ≥30 kg/m2, hypertensive disorder of pregnancy in a prior pregnancy, chronic hypertension, and cesarean birth (p < 0.05) compared with those who delivered following PPROM. Composite perinatal morbidity or death did not differ between groups (aOR = 1.60, 95% CI: 0.89, 2.85, p = 0.11), but fetal death was significantly higher in the PE-SF group (aOR = 6.04, 95% CI: 1.42, 25.71). Neonates delivered for PE-SF were more likely to be SGA (aOR = 13.45, 95% CI: 2.92, 61.94). Composite maternal morbidity did not differ between groups (aOR = 1.18, 95% CI: 0.62, 2.26).

Conclusion

Second-trimester preterm birth indicated for PE-SF was associated with a higher rate of fetal death than birth for PPROM. Composite neonatal and maternal morbidity did not differ by indication.

Key Points

  • Fetal death occurred more frequently in individuals with PE-SF compared with PPROM in the second trimester.

  • Composite perinatal and maternal outcomes were similar between groups.

  • Our findings can be used for risk stratification and survival prediction rates.

Keywords

preterm - maternal morbidity - perinatal morbidity - fetal death - chorioamnionitis

Data Availability Statement

The data are not currently publicly available and are not available upon request.


‡ The other members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network are listed in the [Supplementary Appendix].


Note

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


Supplementary Material



Publication History

Received: 22 November 2025

Accepted: 28 January 2026

Accepted Manuscript online:
30 January 2026

Article published online:
20 February 2026

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