Abstract
SummaryBackgroundThe optimal mode of delivery as a predictor for outcomes in preterm infants is under debate. The purpose of this study was to evaluate the effect of the delivery mode on neonatal outcome among preterm infants in different birthweight categories.MethodsA retrospective analysis of singleton preterm deliveries from 23 + 0 to 33 + 6 gestational weeks was performed. Infants were categorized based on birthweight as large for gestational age (LGA), appropriate for gestational age (AGA) and small for gestational age (SGA). The Apgar score at 5 min served as the main outcome parameter. A sensitivity analysis was performed to adjust for maternal age, parity and fetal malformations as potential confounders.ResultsOut of 1320 singleton preterm infants, 970 (73.5%) were delivered by cesarean section and 350 (26.5%) were delivered vaginally. The AGA infants between 23 + 0 and 27 + 6 weeks showed better outcomes after cesarean section (p < 0.01 from 23 + 0–24 + 6; p = 0.03 from 25 + 0–27 + 6), whereas AGA infants between 31 + 0 and 33 + 6 gestational weeks showed better outcomes after vaginal delivery (p = 0.02). Cesarean section was beneficial in extremely and very preterm SGA infants (p = 0.01 from 25 + 0–27 + 6; p = 0.02 from 28 + 0–30 + 6). The sensitivity analysis showed no confounding effect of other variables.ConclusionThere is a benefit from cesarean section in AGA preterm infants until 28 weeks of gestation and in SGA preterm infants until 31 weeks of gestation. Vaginal delivery should be chosen for moderately preterm AGA infants.
Highlights
Despite the improvement in the prognosis of preterm infants in recent decades, extremely preterm infants still suffer from high morbidity and mortality [1]
There is a benefit from cesarean section in appropriate for gestational age (AGA) preterm infants until 28 weeks of gestation and in small for gestational age (SGA) preterm infants until 31 weeks of gestation
Vaginal delivery should be chosen for moderately preterm AGA infants
Summary
Despite the improvement in the prognosis of preterm infants in recent decades, extremely preterm infants still suffer from high morbidity and mortality [1]. In the 1990s cesarean section for deliveries at gestation less than 28 weeks was rarely performed; with improving perinatal and neonatal care, cesarean section for preterm infants has become popular due to better postnatal care management for very low birthweight infants. The optimal mode of delivery in the preterm period continues to be debated by perinatologists. Studies have reported inconsistent results on the relationship between the mode of delivery and neonatal outcomes [2]. Even the latest Cochrane review could not provide clear evidence for the optimal delivery mode among women with preterm labor. Alfirevic et al [3] reported equal rates of neonatal asphyxia, respiratory distress syn-
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