Mode of delivery and pregnancy outcomes in preterm birth: a secondary analysis of the WHO Global and Multi-country Surveys

Bao Yen Luong Thanh,Joshua P Vogel,Joã Souza,Kapila Jayaratne,Olufemi T Oladapo,Pisake Lumbiganon,Zahida Qureshi,Malinee Laopaiboon,Rintaro Mori,Cynthia Pileggi-Castro,Porjai Pattanittum

doi:10.1038/s41598-019-52015-w

Abstract

Many studies have been conducted to examine whether Caesarean Section (CS) or vaginal birth (VB) was optimal for better maternal and neonatal outcomes in preterm births. However, findings remain unclear. Therefore, this secondary analysis of World Health Organization Global Survey (GS) and Multi-country Survey (MCS) databases was conducted to investigate outcomes of preterm birth by mode of delivery. Our sample were women with singleton neonates (15,471 of 237 facilities from 21 countries in GS; and 15,053 of 239 facilities from 21 countries in MCS) delivered between 22 and <37 weeks of gestation. We assessed association between mode of delivery and pregnancy outcomes in singleton preterm births by multilevel logistic regression adjusted for hierarchical data. The prevalences of women with preterm birth delivered by CS were 31.0% and 36.7% in GS and MCS, respectively. Compared with VB, CS was associated with significantly increased odds of maternal intensive care unit admission, maternal near miss, and neonatal intensive care unit admission but significantly decreased odds of fresh stillbirth, and perinatal death. However, since the information on justification for mode of delivery (MOD) were not available, our results of the potential benefits and harms of CS should be carefully considered when deciding MOD in preterm births.

Highlights

Preterm birth defined as birth before 37 completed weeks of gestation or fewer than 259 days since the first day of a woman’s last menstrual period[1]
We found that maternal age, maternal education attainment, parity, underlying disease, preeclampsia and eclampsia, gestational age, fetal presentation, corticosteroids administration, newborn’s sex and birthweight were significantly different between Caesearean Section (CS) and vaginal birth (VB) in both WHOGS and WHOMCS; but marital status was significantly different only in WHOMCS
0.4 (0.2–0.6) in Global Survey (GS) and 0.4 (0.3–0.6) in Multi-country Survey (MCS)) and perinatal death (aORs: 0.6 (0.5–0.8) in GS and 0.6 (0.5–0.8) in MCS) compared to those delivered by VB

Summary

Introduction

Preterm birth defined as birth before 37 completed weeks of gestation or fewer than 259 days since the first day of a woman’s last menstrual period[1]. Many studies have been conducted to assess whether Caesearean Section (CS) or vaginal birth (VB) confers benefits to preterm newborn with minimal harms to mother in preterm birth, but mostly in high-income contries and limited in low- and middle-income countries. There is little high-quality trial data regarding effects of MOD on outcomes for preterm neonates to guide clinical practice. A clear understanding of maternal and newborn outcomes for different modes of preterm birth could guide clinicians and mothers in making appropriate decisions. This analysis aimed to investigate the relationship between MOD and pregnancy outcomes among women giving preterm birth in two large WHO multi-country surveys

Methods

Results

Conclusion