Survival Advantage Associated With Cesarean Delivery in Very Low Birth Weight Vertex Neonates

Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, California 94304, USA.
Obstetrics and Gynecology (Impact Factor: 5.18). 06/2006; 107(1):97-105. DOI: 10.1097/01.AOG.0000192400.31757.a6
Source: PubMed


To identify the indications for and any survival advantage associated with very low birth weight (VLBW) neonates delivered by cesarean.
Maternal and infant data from the National Center for Health Statistics linked birth/death data set for 1999 to 2000 were analyzed. Maternal conditions associated with cesarean delivery were compared among birth weight groups for vertex neonates. Birth weight-specific 28-day mortality rates and relative risks were calculated with 95% confidence intervals. Multivariate logistic regression was performed to adjust for other factors that may be associated with survival.
Cesarean delivery occurred frequently, more than 40% in most VLBW birth weight groups. Conditions associated with cesarean delivery in VLBW vertex neonates differed from those seen in non-VLBW vertex neonates. A survival advantage was associated with cesarean delivery in the birth weight analysis up to 1,300 g (P < .05). This decreased mortality for VLBW neonates delivered by cesarean persisted after adjusting for other factors associated with mortality.
Very low birth weight vertex neonates are often born by cesarean delivery and have different maternal risk profiles from non-VLBW vertex neonates born by this route. Neonatal mortality was decreased in VLBW neonates delivered by cesarean. Further study is warranted to determine whether this may be a causal relationship or a marker of quality of care.

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    • "After adjusting for gestational age, maternal age, parity, pregnancy interval and other variables, the relationship between delivery type and LBW was not significant. As cesarean section occurred frequently in most very low birth weight groups[16] and complicated pregnancies. "
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    ABSTRACT: Objective This study was conducted to determine the prevalence of low birth weight (LBW) and its related risk factors in an appropriate sample of neonates in Shahroud, northeast Iran. Methods At this study, a random sample of 1000 neonates were selected of which 72 neonates were LBWs. We used univariate and multivariate logistic regression methods to evaluate the LBW risk factors in LBWs compared to normal weight infants. Findings 7.2% of neonates were LBWs and 6.1% born before 37 weeks of gestation. Prematurity, high-risk pregnancy and maternal age have significant statistical association with LBW. Odds Ratio (OR) for prematurity was 42.82 (95%CI; 21.93-83.57), for high risk pregnancy 2.76 (95%CI; 1.47-5.19) and for maternal age group more than 35 years in comparison to 19-35 years age group 0.2 (95%CI; 0.05-0.71). Conclusion Based on this study; prematurity and high risk pregnancy were the most important risk factors for LBW. There was also a reverse association between maternal age and LBW.
    Iranian Journal of Pediatrics 12/2013; 23(6):701-4. · 0.26 Impact Factor
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    • "In terms of the incidence of maternal illness in the survival group and death group, the frequency of nonvertex presentation [17], vaginal delivery [14], and placental abruption [14, 18], which can generally be risk factors, was also significantly high in this study in the death group. However, it is very interesting that the occurrence of preterm rupture of membranes (PROM) and nonreassuring fetal status (NRFS) was significantly high in the survival group. "
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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(2):873563. DOI:10.1155/2013/873563
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    • "First was a study [15] done in the United states which found that Caesarean section does seem to provide survival advantages for the most immature infants delivered at 22 to 25 weeks of gestation, independent of maternal risk factors for Caesarean section. Two other reports [16, 17] agreed to this finding and showed that survival advantage was associated with Caesarean delivery in the birth weight group of 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(12):186560. DOI:10.1155/2011/186560
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