550: Dellivery mode and intraventricular hemorrhage in early preterm infants

Abstract

To assess the effects of mode of delivery on the risk of severe intraventricular hemorrhage (IVH) (grade 3 or 4) in early preterm birth. This is a retrospective study of 359 infants delivered at 22-28 weeks of gestation between January 2011 and December 2017 at a tertiary center. Study subjects were divided into vaginal delivery group (n=105) and cesarean delivery group (n=254). We also performed subgroup analysis by stratifying gestational age at delivery <26 and ≥26 weeks of gestation. Univariable and multivariable analysis were used to compare the rates of IVH and mortality between the two groups. There was no significant difference in the rate of IVH (vaginal vs. cesarean; 15.2 vs. 9.4%, P=0.275). Also, there was no difference in the rate of IVH in the neonates born <26 and ≥26 weeks of gestation (22.0 vs. 14.0%, P=0.200, 9.1 vs. 6.5%, P=0.724), respectively. Meanwhile, neonatal mortality rate was significantly lower in the cesarean delivery group (29.5% vs. 18.9%, P=0.027). However, this difference was not observed after excluding unintended non-vertex vaginal delivered cases (16.3% vs. 10.6%, P=0.144). Multiple logistic regression analysis also showed that cesarean delivery could not decrease the rate of IVH [(adjusted odds ratio (aOR) 1.695; 95% confidence interval (CI) 0.816-3.523)] and mortality (aOR; 0.613; 95% CI 0.301-1.248). Cesarean delivery in preterm births at 22-28 weeks of gestation could not decrease the rate of IVH or mortality. Therefore, mode of delivery at this early gestational period could be decided based on obstetrical indications.