Delivery mode for the extremely premature fetus: a statement of the prematurity working group of the World Association of Perinatal Medicine

Abstract

Recent retrospective publications have suggested that cesarean delivery may be beneficial for the extremely premature fetus. This article displays the available evidence and discusses this issue, including many aspects such as the difficulty in deciding when delivery is imminent, the negative impact on maternal morbidity and mortality and the cost to society of such a policy. The available scientific evidence does not support a recommendation for cesarean delivery for improving survival or decreasing morbidity for the extremely premature fetus.

Neonatal outcomes of preterm infants in breech presentation according to mode of birth in Canadian NICUs

“…Obstetricians are uncertain about the management of the preterm infant in breech or cephalic presentation during labour 11 12. Most hospitals have adopted the practice of CS for such infants based on term infant data 13.…”

Perinatal factors associated with neonatal mortality in very low birth weight infants: a multicenter study

“…17 Although this is a highly controversial topic, some retrospective studies indicate that the rate of prematurity-related complications may be reduced if the child is born via C-section. 18,19 These results underline the need for an early screening of antenatal RFs and an adequate labor and NBI resuscitation in relation to mortality and GA, BW, intrauterine growth restriction, and neonatal asphyxia. The wide inter-site variability has also been reported in other studies, 20,21 and it may be accounted for by both each unit population characteristics and inherent risks, and the diagnostic and therapeutic interventions implemented in each site, especially professional conduct when providing care to preterm infants born at the threshold of viability.…”

Factores perinatales asociados a la mortalidad neonatal en recién nacidos de muy bajo peso: estudio multicéntrico

“…17 Aunque el tema es muy controvertido, algunos estudios retrospectivos indican que puede haber una reducción de la tasa de complicaciones relacionadas con la prematuridad cuando el niño nace por cesárea. 18,19 Estos resultados resaltan lo imperativo de la pesquisa precoz de FR prenatales y una adecuada conducción del trabajo de parto y reanimación del RN en su relación entre mortalidad y EG, PN, restricción del crecimiento y asfixia al nacer.…”