No Mortality Benefit With Vertex-Status Early Preterm C-Section
Mortality up with vaginal route versus cesarean for early preterm delivery of breech presentation
FRIDAY, Aug. 10 (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, according to a study published in the August issue of the American Journal of Obstetrics & Gynecology.
To examine neonatal outcomes in early preterm birth by route of delivery, Uma M. Reddy, M.D., M.P.H., 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 through 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 percent); preterm premature rupture of membranes (37.7 percent), and preterm labor (16.6 percent). For those with vertex presentation, 84 percent of the 79 percent 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 through 27 6/7 weeks of gestation, 27.6 percent of the 31.7 percent who attempted vaginal delivery were successful, but neonatal mortality was increased when compared with planned cesarean delivery (25.2 versus 13.2 percent, respectively). For those with breech presentation at 28 0/7 through 31 6/7 weeks of gestation, 17.2 percent of the 30.5 percent attempting vaginal delivery were successful, with increased neonatal mortality (6.0 versus 1.5 percent).
"Selecting a route of delivery at less than 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 less than 32 weeks' gestation, we saw no improvement in neonatal mortality with a planned cesarean delivery."