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

BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.86). 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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    ABSTRACT: Abstract Background: Pregnancy induced hypertension (PIH) has been associated with a decreased risk of infant mortality in small for gestational age (SGA) preterm infants. Objective: To evaluate the influence of PIH on mortality and major neonatal morbidities in singleton preterm SGA infants, in the presence and absence of acute pregnancy complications. Methods: Population-based observational study of singleton SGA infants, born at 24 to 32 weeks gestation in the period 1995-2010 (n=2139). Multivariable logistic regression analyses were used to assess the independent effect of PIH on mortality and neonatal morbidities. Acute pregnancy complications comprised premature labour, premature rupture of membranes >6 hours, antepartum haemorrhage and clinical chorioamnionitis. Results: In the absence of pregnancy complications the odds ratio (95% confidence interval) for mortality (0.77; 0.50-1.16), survival without severe neurological morbidity (1.14; 0.79-1.65) and survival without bronchopulmonary dysplasia (BPD) (0.85; 0.59-1.21) were similar in the PIH vs. no-PIH groups. In the presence of pregnancy complications, mortality (0.76; 0.40-1.44), survival without severe neurological morbidity (1.16; 0.64-2.12) and survival without BPD (1.04; 0.58-1.86) were also similar in the PIH vs. no-PIH groups. Conclusions: PIH was not associated with improved outcome in preterm SGA infants, both in the presence and absence of acute pregnancy complications.
    Journal of Maternal-Fetal and Neonatal Medicine 05/2014; DOI:10.3109/14767058.2014.928851 · 1.21 Impact Factor
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    ABSTRACT: To compare neonatal mortality and neurodevelopmental outcomes at two years of age in very low birth weight infants (≤1500 g) born by cesarean with those by vaginal delivery.
    World Journal of Pediatrics 08/2014; 10(3):227-31. DOI:10.1007/s12519-014-0497-6 · 1.05 Impact Factor
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    ABSTRACT: Abstract Objective: To investigate the association of perinatal risk factors including delivery mode with mortality in very low birthweight (VLBW) in a tertiary hospital setting. Methods: Medical records of 241 live-born VLBW infants (≤1500 g) were retrospectively reviewed. Details of maternal, obstetrical, perinatal risk factors and their associations with infant mortality were evaluated. Results: The overall infant mortality rate was 23.2%. Mortality was significantly higher for infants born at ≤27 gestational weeks and with a birthweight of ≤750 g (p = 0.000 and p = 0.000, respectively), showing a steep decrease thereafter. On ROC analysis, a cut off of 26.5 weeks was determined for mortality with a sensitivity of 57.1% and a specificity of 90.3% (area under the curve = 0.792, 95% CI: 0.719-0.866). On multivariate regression analysis, gestational week at birth, birthweight, antenatal steroid treatment and pathologic Doppler ultrasound findings were found as independent risk factors for mortality. Conclusions: Gestational week at birth, birthweight and antenatal steroid treatment remain the most important perinatal risk factors for infant mortality in VLBW infants. Mode of delivery does not seem to be associated with mortality when adjusted for other perinatal risk factors.
    Journal of Maternal-Fetal and Neonatal Medicine 09/2014; DOI:10.3109/14767058.2014.953476 · 1.21 Impact Factor

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