Mode of Delivery in the Low Birth Weight Fetus. Delivery by Cesarean Section Independent of Fetal Lie Versus Vaginal Delivery in Vertex Presentation

Abstract

In a paired controlled multicenter study of patients in preterm labor of unknown etiology without additional maternal or fetal complications, 59 low birth weight infants in vertex presentation born vaginally were compared with 59 infants delivered by cesarean section. In the early postpartum period, hypothermia and acidosis occurred more often in the vaginal delivery group. The rate of respiratory disorders and need for assisted ventilation did not differ between the groups. Persistent ductus arteriosus occurred in 19% in the vaginal delivery group and in 7% in the abdominal delivery group. At follow-up until 18-24 months of age the rate of cerebral palsy did not differ between the groups, whereas the rate of psychomotor retardation was significantly higher in the vaginal delivery group (p less than 0.05). The difference in percentage of total outcome, i.e. sum of mortality and neurodevelopmental sequelae, being 20.3% in the vaginal delivery group versus 8.5% in the cesarean section group, fails to reach a statistical significance, but the results suggest that for the low birth weight infants, vaginal delivery may be more hazardous than abdominal delivery.

Low Birthweight Breech Infant: Short-Term and Long-Term Outcome by Method of Delivery

“…Our findings indicate that, in addition to the better short-term outcome, the longterm morbidity may be reduced and life quality improved by allowing more cesarean deliveries in these weight groups. This finding is in accordance with the paired, controlled, multicentric study reported by Westgren et al 14 on 59 very low birthweight vertexpresenting infants. Although cerebral palsy rate was similar in the vaginally and abdominally delivered infants, psychomotor retardation was significantly higher in the vaginal delivery group, which was followed up until the children were 24 months of age.…”

Untersuchungen des perinatalen Zustandes bei frühgeborenen Kindern mit weniger als 1500 g

“…¾ltere Studien konnten ein deutlich erhöhtes fetales Risiko mit peri-und intraventrikulärer Hirnblutung und bronchopulmonaler Dysplasie bei Vaginalgeburten zeigen. Die Sectio caesarea wurde als der prognostisch günstigere Geburtsmodus bei VLBW-Kindern angesehen [2,3]. Zum Zeitpunkt dieser Untersuchungen waren jedoch noch keine Surfactantgabe zur Unterstützung der alveolären Funktion sowie die aktuell hoch entwickelte neonatologische Intensivtherapie vorhanden.…”

“…Einige Studien zeigten bei der Vaginalgeburt eine erhöhte Rate an Todesfällen mit peri-und intraventrikulärer Hirnblutung, welche durch die belastende Geburt durch den Geburtskanal erklärt wurden. Andere Studien belegten, dass eine Sectio caesarea die Prognose von VLBW-Kindern verbessert [2,3].…”

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“…It has been suggested by others that low-birth-weight and periviable neonates may lack the reserve necessary to tolerate stress incurred during labor and during the course of a vaginal delivery. [7][8][9][10][11][12][13][14] While definitive objective evidence for this is lacking, epidemiological studies suggest that cesarean delivery (CD) rate among preterm, low-birth-weight infants continues to rise. [15][16][17] This is notable in light of nationwide efforts to decrease the overall CD rate, which currently is estimated at 31%; frequently CD performed at the threshold of viability or among very low-birth-weight (VLBW) infants is low vertical or classical hysterotomy incisions and thus obligates the gravidae to subsequent CD thereafter.…”