(260) Reasons for Hospitalization at Periviable Gestation, Interventions, and Subsequent Delivery

Objective:
Management at periviable gestation (20+0 - 25+6 wk) has changed during the past decade. Prior studies have focused on birth outcomes, yet there has been little insight into characteristics and management of all individuals who are hospitalized in this gestational age range.  This study aimed to describe the reasons, interventions, and probability of delivery among pregnant patients hospitalized during periviable gestational ages.

Study Design:
This was a prospective multicenter cohort study of inpatient hospitalizations at periviable gestation May 2024 - April 2025 at 12 hospitals. All patients with hospitalizations with a live fetus at admission were included except when admission was for termination for reasons other than rupture of membranes, preeclampsia, maternal infection, or vaginal bleeding. Key measures included reasons for hospitalization, antenatal steroids, and antenatal counseling from a neonatal clinician. We calculated the probability of delivery after admission for each reason and for each intervention.

Results:
Among 1738 pregnant patients, the median (interquartile range) gestation at first hospitalization was 22.9 (21.4-24.3) weeks and median duration of hospitalization was 2 (1-5) days; 197 patients (11.3%) had multiple hospitalizations and 520 (29.9%) delivered at a periviable gestational age. The reasons for hospitalization with greatest probability of periviable delivery were (Table 1) preterm labor (n=222, 74.8% delivered) and premature rupture of membranes (267, 62.9% delivered). Of the 655 patients who received antenatal steroids, 418 (63.8%) delivered during hospitalization. Of the 554 patients who received counseling from a neonatal clinician, 375 (67.7%) delivered during hospitalization.

Conclusion:
The probability of delivery, antenatal steroids, and antenatal counseling varied substantially by reason for admission. One-third of patients hospitalized at periviable gestation who received antenatal steroids or counseling from a neonatal clinician did not deliver during hospitalization.