515: Cesarean delivery in extreme preterm birth does not improve survival or survival without severe morbidity

Abstract

515 Cesarean delivery in extreme preterm birth does not improve survival or survival without severe morbidity Michael Trifiro, Sima Parmar, Guibo Xing, Bryon Jacoby University of California Davis Medical Center, Obstetrics and Gynecology, Sacramento, CA, University of California Davis Medical Center, Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, Sacramento, CA, University of California Davis Medical Center, Center for Healthcare Policy and Research, Sacramento, CA OBJECTIVE: To determine if mode of delivery affects survival of extremely preterm neonates. STUDY DESIGN: This is a retrospective cohort study of early preterm deliveries between 22 weeks 0 days and 27 weeks 6 days occurring between January 1, 2000 and December 31, 2009 at the University of California Davis Medical Center. Genetic abortions and inductions for stillbirths were not included. Maternal characteristics, obstetrical data, and neonatal information were collected. Statistical analysis was performed to evaluate obstetrical and neonatal factors associated with total survival and survival without a severe morbidity. Severe morbidities included intraventricular hemorrhage 3, periventricular leukomalacia, retinopathy of prematurity 3, necrotizing enterocolitis, or broncho-pulmonary dysplasia. RESULTS: Over the study period, 238 early preterm births occurred. Factors associated with improved survival included weeks gestation (p 0.0001), birthweight (p 0.0001), female gender (OR 2.12 95% CI 1.20-3.72), and steroid administration (OR 4.85 95% CI 2.678.83). 146 deliveries were by cesarean section and 92 deliveries were vaginal. Delivery by cesarean section was associated with improved survival in univariate analysis (OR 2.15 95% CI1.23-3.77), but this association was not significant in multivariate analysis adjusting for birthweight, gender and steroid administration (OR 1.85 95% CI 0.89-3.87). There was no association with cesarean section and survival to discharge without severe morbidity in univariate (OR 1.35 95% CI 0.79-2.28) or multivariate analyses (OR 1.15 95% CI 0.582.27). CONCLUSION: Delivery of the extremely preterm neonate is complicated with limited data to guide care and counseling. A limited number of studies have compared mode of delivery in extreme preterm birth and there is insufficient evidence to support cesarean delivery in extremely preterm neonates. In this study, cesarean delivery was not associated with total survival or survival without severe morbidity in multivariate analysis.