The Impact of Mode of Delivery on Early Preterm Morbidity and Mortality [32K

Abstract

INTRODUCTION: Whether the mode of delivery for early preterm infants influences the risk of adverse outcomes is an ongoing topic of debate. This study aims to determine whether cesarean delivery is independently associated with improved early preterm neonatal morbidity or mortality. METHODS: This is a retrospective cohort study of preterm deliveries at 22.0–29.0 weeks gestation between 2010 and 2015, excluding multiple gestations, intrauterine fetal demise, and induction terminations. The primary outcome was a neonatal morbidity composite (apgar <5 at 5 min, prolonged ventilation >28 days, IVH, NEC, coagulopathy, discharged on home ventilator support, or discharged with enteric feeding tube). The secondary outcome was neonatal death. Outcomes were compared between patients who underwent cesarean vs vaginal delivery. Patients were first matched for ethnicity (black v. other). Propensity scores were estimated utilizing logistic regression models adjusting for small for gestational age, gestational at delivery, and nulliparity. IRB approval was granted through Washington University. RESULTS: Of the 273 (56.9%) early preterm deliveries, 125 (45.8%) were cesarean deliveries and 148 (54.2%) were vaginal deliveries. After matching, there were 115 patients in each group. In vertex fetuses, there was no significant difference in neonatal mortality within 24 hours (aOR 1.48 CI 0.56, 3.90) or within 28 days of delivery (aOR 0.71 CI 0.27, 1.90) by mode of delivery. There was no difference in composite neonatal morbidity. CONCLUSION: In this propensity score analysis, the risk of neonatal death or neonatal morbidity was not significantly improved among early preterm neonates delivered by cesarean versus vaginal delivery.