Neonatal mortality by attempted route of delivery in early preterm birth

Am J Obstet Gynecol. 2012 Aug;207(2):117.e1-8. doi: 10.1016/j.ajog.2012.06.023. Epub 2012 Jun 19.

Abstract

Objective: We sought to study neonatal outcomes in early preterm births by delivery route.

Study design: Delivery precursors were analyzed in 4352 singleton deliveries, 24 0/7 to 31 6/7 weeks' gestation. In a subset (n = 2906) eligible for a trial of labor, neonatal mortality in attempted vaginal delivery (VD) was compared to planned cesarean delivery stratified by presentation.

Results: Delivery precursors were classified as maternal or fetal conditions (45.7%), preterm premature rupture of membranes (37.7%), and preterm labor (16.6%). For vertex presentation, 79% attempted VD and 84% were successful. There was no difference in neonatal mortality. For breech presentation, at 24 0/7 to 27 6/7 weeks' gestation, 31.7% attempted VD and 27.6% were successful; neonatal mortality was increased (25.2% vs 13.2%, P = .003). At 28 0/7 to 31 6/7 weeks' gestation, 30.5% attempted VD and 17.2% were successful; neonatal mortality was increased (6.0% vs 1.5%, P = .016).

Conclusion: Attempted VD for vertex presentation has a high success rate with no difference in neonatal mortality unlike breech presentation.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Intramural

MeSH terms

  • Abnormalities, Multiple / epidemiology
  • Asphyxia Neonatorum / mortality
  • Cerebral Hemorrhage / mortality
  • Cesarean Section / statistics & numerical data*
  • Cohort Studies
  • Delivery, Obstetric / statistics & numerical data*
  • Female
  • Fetal Membranes, Premature Rupture / epidemiology
  • Gestational Age
  • Humans
  • Infant Mortality*
  • Infant, Newborn
  • Labor Presentation*
  • Multivariate Analysis
  • Obstetric Labor, Premature / epidemiology
  • Pre-Eclampsia / epidemiology
  • Pregnancy
  • Premature Birth*
  • Trial of Labor