The relationship between delivery mode and mortality in very low birthweight singleton vertex‐presenting infants

Abstract

Objective To investigate the factors associated with caesarean delivery and the relationship between mode of delivery and mortality in singleton vertex‐presenting very low birthweight (≤1500 g) live born infants. Design Observational population‐based study. Setting Data collected from all 28 neonatal departments comprise the Israel National Very Low Birth Weight Infant Database. Population 2955 singleton vertex‐presenting very low birthweight infants registered in the database from 1995 to 2000, and born at 24–34 weeks of gestation. Methods The demographic, obstetric and perinatal factors associated with caesarean delivery and subsequent mortality were studied. The independent effect of the mode of delivery on mortality was tested by multiple logistic regression. Main outcome measure Mortality was defined as death prior to discharge. Results Caesarean delivery rate was 51.7%. Caesarean delivery was directly associated with increasing maternal age and gestational age, small for gestational age infants, maternal hypertensive disorders and antepartum haemorrhage, and was inversely related to premature labour and prolonged rupture of membranes. Factors associated with increased survival were increasing gestational age, antenatal corticosteroid therapy, maternal hypertensive disorders and no amnionitis. Mortality rate prior to discharge was lower after caesarean delivery (13.2%vs 21.8%), but in the multivariate analysis, adjusting for the other risk factors associated with mortality, delivery mode had no effect on infant survival (OR 1.00, 95% CI 0.74–1.33). In a subgroup with amnionitis, a protective effect of caesarean delivery was found. Conclusions Caesarean delivery did not enhance survival of vertex‐presenting singleton very low birthweight babies. Caesarean delivery cannot be routinely recommended, unless there are other obstetric indications.

Neonatal Mortality by Attempted Route of Delivery in Early Preterm Birth

“…1 The optimal route of delivery for the early preterm fetus remains controversial. Some observational studies have shown a lower neonatal mortality for planned cesarean delivery as compared with vaginal delivery for vertex [2][3][4] and breech early preterm pregnancies 2, 4-9 whereas other studies do not show a difference by route of delivery for vertex [10][11][12] or breech presentation. [13][14][15] The vertical uterine incision often required for cesarean delivery at this gestational age increases the risks of hemorrhage, bladder injury and other complications.…”

Health Outcomes for Vaginal Compared With Cesarean Delivery of Appropriately Grown Preterm Neonates

“…Additionally, Lee at al showed a decrease in mortality with vaginal delivery in appropriately grown preterm neonates (3). Other studies have found no significant difference between cesarean and vaginal deliveries with regard to neonatal outcomes in appropriately grown premature neonates (4,5,6). Even in small for gestational age neonates, a prior study by the authors of this paper found no difference in neonatal outcomes between cesarean and vaginal deliveries except with regard to neonatal respiratory distress, which was moderately decreased with vaginal delivery (7).…”

How are Premature Babies Born?

“…Very recently, in France, a study of 626 singleton breech-presenting premature infants at [26][27][28][29] +6 GW reported that the mode of delivery was not related to mortality (24). In a retrospective study of a very large series, 1854 premature babies who were born on the edge of life (23-24 GW) were examined, and it was determined that the mode of delivery did not affect mortality in breech-presenting babies with birth weights <500 g and in newborns intubated for 6 months (25).…”

“…Riskin et al (27) indicated that in 2955 singleton vertex-presenting infants born with <1500 g birth weights at 24-34 GW, cesarean section did not prevent mortality after a logistic re-gression analysis. Thus, unless an obstetric indication is present, cesarean section should not be recommended in premature babies.…”