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

BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.45). 11/2004; 111(12):1365 - 1371. DOI: 10.1111/j.1471-0528.2004.00268.x

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.

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Available from: Shlomit Riskin-Mashiah, Sep 23, 2014
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    • "There are not likely any who would voice a dissenting opinion to this. On the other hand, the occurrence of pregnancy induced hypertension (PIH), which is often seen in other reports [20, 21], was hardly seen at all and was not a risk factor. This was probably because the cases included in the present study were infants delivered in the second trimester, that is, weeks 26-27 of gestation, unlike other reports to date, because this study was limited to ELBW infants weighing less than 1,000 g. "
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    ABSTRACT: Aim. To clarify the effect of perinatal events on the survival of ELBW infants in Japan. Methods. 1,713 ELBW infants, from 92,630 live births in 2001 and 2002, born at 22-36 weeks of gestation were registered. Case was defined as death at discharge. The relevant variables were compared between the cases (n = 366) and the controls (n = 1,347). Results. The total survival rate was 78.6%. There was a significant difference between the survival rate in cesarean and vaginal delivery at 24-31 weeks of gestation. Cesarean delivery in infants with a birth weight >400 g was significantly advantageous to the survival rate of ELBW infants than vaginal delivery. The significant contributing factors were gestational age at delivery (OR: 0.97), Apgar score at 5 min (0.56), antenatal steroid (0.41), and birth weight (0.996). Nonvertex presentation (1.81), vaginal delivery (1.56), and placental abruption (2.50) were found to be significantly associated with neonatal death. Conclusions. Cesarean section might be advantageous for survival in ELBW infants over 24 gestational weeks or 400 grams of birth weight. Nonvertex presentation, vaginal delivery, and placental abruption could be significant risk factors for survival of ELBW infants.
    ISRN obstetrics and gynecology 11/2013; 2013:873563. DOI:10.1155/2013/873563
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    • "Therefore, recent evidence regarding this question is conflicting. Three studies [12–14] suggest that Caesarean section does not enhance survival of vertex-presenting singleton very low birth weight babies and cannot be routinely recommended unless there are other obstetric indications. Other three [15–17] have found Caesarean delivery to be beneficial in infants less than 26 weeks of gestation or birth weight less than 1300 g. "
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    ABSTRACT: Choosing the safest method of delivery and preventing preterm labour are obstetric challenges in reducing the number of preterm births and improving outcomes for mother and baby. Optimal route of delivery for preterm vertex neonates has been a controversial topic in the obstetric and neonatal community for decades and continues to be debated. We reviewed 22 studies, most of which have been published over the last five years with an aim to find answers to the clinical questions relevant to deciding the mode of delivery. Findings suggested that the neonatal outcome does not depend on the mode of delivery. Though Caesarean section rates are increasing for preterm births, it does not prevent neurodisability and cannot be recommended unless there are other obstetric indications to justify it. Therefore, clinical judgement of the obstetrician depending on the individual case still remains important in deciding the mode of delivery.
    Journal of pregnancy 07/2011; 2011:186560. DOI:10.1155/2011/186560
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    ABSTRACT: SüleymanDemirel Üniversitesi TIP FAKÜLTESİ DERGİSİ: 2007 Mart; 14(1) Prematür gebeliklerde doğum yöntemleri Mekin Sezik, Okan Özkaya SDÜ Tıp Fakültesi Kadın Hastalıkları ve Doğum AD, Isparta Özet Prematür doğum, perinatal mortalite artışı ve uzun dönemde kötü sonuçlara yol açabilen, önemli bir obstetrik problemdir. İyi kontrollü çalışmalarda, sezaryen doğumun özellikle düşük kilolu ve verteks gelişli bebeklerde ek avantaj sağlamadığı sonucuna varılmıştır. Ancak 1500 g altında doğum ağırlığı azaldıkça vajinal doğumun riski artmaktadır. Preterm makat gelişlerde sezaryen doğumu önermek için yeterli veriye sahip değiliz. Fakat tahmini doğum ağırlığı 1500 g ve altında ise, önde gelen kısımdan bağımsız olarak sezaryen doğum daha güvenli olabilir. Bu konuda daha fazla çalışmaya ihtiyaç duyulmaktadır. Anahtar kelimeler: Prematür gebelik, Doğum Yöntemi, Sezaryen Abstract Mode of delivery in premature pregnancies Premature birth is an important obstetric problem associated with increased perinatal mortality and poor long-term outcomes. Properly-controlled studies have demonstrated no additional benefit of cesarean delivery in low-birthweight infants with vertex presentation. However, hazards of vaginal delivery seem to increase with decreasing birthweight below 1500 g. We do not have sufficient data to recommend cesarean delivery for all cases of preterm breech presentation. Nevertheless, cesarean section might be safer if estimated birthweight is less than 1500 g regardless of fetal presentation. Further investigations are needed on this controversial issue. Key words: Premature Pregnancy, Mode of Delivery, Cesarean
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