Effect of delivery method on outcomes in the very low-birth weight breech infant: is the improved survival related to cesarean section or other perinatal care maneuvers?
ABSTRACT The perinatal mortality rate among very low-birth weight infants has been decreased by 20% during the last 4 years of the 1973 to 1980 period here reported. The concurrent increase in the cesarean section rate from 11.9% to 49.1% during the same time frames has been assumed to be responsible for the improved outcome. The changes were most marked in the extremely low-birth weight group (less than 1,000 gm). The survival rates and cesarean section rates were examined among infants of similar birth weight and gestational age in the vertex presentation, in the same time frames. A similar or greater reduction in mortality rate (from 85% to 45%) was noted in the very low-birth weight vertex infants, whereas the cesarean section rate remained minimally and not significantly increased (14.2% to 22.2%). The interpretation of this finding is by no means clear but must include the hypothesis that the increased cesarean section rate may be incidental and in no way related to the improved outcome. The most statistically significant determinants of outcome remain birth weight and gestational age strata, with no significant difference in outcomes when the extremely low-birth weight group is analyzed separately from the entire very low-birth weight group. As yet unidentified perinatal care practices, other than cesarean section, may be more likely to affect outcome in this high-risk group.
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ABSTRACT: 398 infants with birthweight (BW) 500-1500 g born from January 2 1982 to December 1983 were studied to determine incidence and survival rate by BW and gestational age (GA) categories and to determine causes of death and factors influencing mortality. 58% of the group survived. Factors other than those in the perinatal and postnatal period did not significantly influence survival. Infants with BW below 1000 g delivered by elective C-section had better survival than those delivered vaginally. Survival increased progressively with increasing BW and GA categories with GA more than BW being the limiting factor. Eleven (6.6%) of the deaths in the very low birth weight infants occurred during the nursery period after 28 days of age. These deaths would not have been addressed in the neonatal mortality.Journal of Perinatal Medicine 02/1987; 15(3):297-306. · 1.70 Impact Factor