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To quantify the rate of maternal complications associated with a periviable birth in a contemporary population of live births in the state of Ohio.We conducted a population-based retrospective cohort study of all live births in Ohio (2006–2015). Maternal, obstetric, and neonatal characteristics were compared between women who delivered in the periviable period (20–25 weeks of gestation) with those who delivered preterm (26–36 weeks of gestation) and at term (greater than 36 weeks of gestation). Women were also stratified by 3-week gestational age epochs (ie, 20–22, 23–25 weeks of gestation). The primary study outcome was a composite of individual adverse maternal outcomes (chorioamnionitis, blood product transfusion, hysterectomy, unplanned operation, and intensive care unit [ICU] admission). Multivariate logistic regression estimated the relative association of periviable birth with maternal complications.Of 1,457,706 live births in Ohio during the 10-year study period, 6,085 live births (0.4%) occurred during the periviable period (20–25 weeks of gestation). The overall rate of the composite adverse outcome was 17.2%. In multivariate analysis, periviable birth was associated with an increased risk of the composite adverse maternal outcome (adjusted relative risk [RR] 5.8, CI 5.4–6.2) and individual complications including transfusion (adjusted RR 4.4, CI 3.4–5.7), unplanned operative procedure (adjusted RR 2.0, CI 1.7–2.4), unplanned hysterectomy (adjusted RR 7.8, CI 4.6–13.0), uterine rupture (adjusted RR 7.1, CI 3.8–13.4), and ICU admission (adjusted RR 9.6, CI 7.2–12.7) compared with the term cohort. Delivery between 20–22 weeks and 23–25 weeks of gestation was associated with the highest risk of composite adverse outcome. The risk of composite adverse outcome decreased with advancing gestational age stratum.Periviable birth is associated with significant maternal morbidity. Nearly one in five women in this cohort had a serious morbidity associated with their periviable delivery.