No Mortality Benefit With Vertex-Status Early Preterm C-Section
(HealthDay News) – For women with singleton deliveries in early preterm births with breech presentation who are eligible for a trial of labor, vaginal delivery correlates with increased neonatal mortality compared with planned cesarean delivery.
To examine neonatal outcomes in early preterm birth by route of delivery, Uma M. Reddy, MD, MPH, from the Eunice Kennedy Shriver National Institute of Child Health and Human Development in Bethesda, MD, and colleagues analyzed delivery precursors in 4,352 singleton deliveries from 24 0/7–31 6/7 weeks of gestation. In a subset of 2,906 who were eligible for a trial of labor, mortality was compared in attempted vaginal delivery and planned cesarean delivery.
The researchers found that delivery precursors could be classified into fetal or maternal conditions (45.7%); preterm premature rupture of membranes (37.7%), and preterm labor (16.6%). For those with vertex presentation, 84% of the 79% who attempted vaginal delivery were successful, with no difference in neonatal mortality when compared with planned cesarean delivery. For those presenting breech at 24 0/7–27 6/7 weeks of gestation, 27.6% of the 31.7% who attempted vaginal delivery were successful, but neonatal mortality was increased when compared with planned cesarean delivery (25.2 vs. 13.2%, respectively). For those with breech presentation at 28 0/7–31 6/7 weeks of gestation, 17.2% of the 30.5% attempting vaginal delivery were successful, with increased neonatal mortality (6.0 vs. 1.5%).
"Selecting a route of delivery at <32 weeks' gestation is a difficult clinical decision given the high rate of infant mortality and morbidity as well as the maternal risks associated with cesarean delivery," Reddy said in a statement. "For vertex-presenting fetuses <32 weeks' gestation, we saw no improvement in neonatal mortality with a planned cesarean delivery."