Method of delivery and neonatal outcome in very low-birthweight vertex-presenting fetuses.
OBJECTIVE
This study was undertaken to compare neonatal outcome by method of delivery in very low-birthweight less than 1500 g vertex-presenting fetuses.


METHODS
A retrospective cohort was conducted of 2466 very low-birthweight singleton liveborn vertex-presenting fetuses in Washington State (1994-2003). The exposure considered was cesarean delivery vs vaginal delivery. The risk of neonatal demise was estimated by logistic regression. Secondary outcomes included intraventricular hemorrhage, respiratory distress, and neonatal sepsis. Analyses were stratified by birthweight, gestational age, and growth restriction to assess subgroup differences.


RESULTS
Cesarean delivery offered no survival advantage to very low-birthweight infants when compared with vaginal delivery (adjusted odds ratio [95% confidence interval]: 1.08 [0.78-1.49]). Survival benefit was noted for growth-restricted infants (adjusted odds ratio [95% confidence interval]: 0.09 [0.02-0.47]) although only 12% of such infants delivered vaginally.


CONCLUSIONS
For very low-birthweight vertex-presenting fetuses at risk of preterm delivery, cesarean delivery does not improve neonatal survival. Further studies are warranted to assess the potential benefit of cesarean delivery to growth-restricted very low-birthweight infants.
Wylie
Blair J
BJ
Department of Obstetrics and Gynecology, New York-Presbyterian Medical Center, New York, NY, USA.
Davidson
Leslie L
LL
Batra
Maneesh
M
Reed
Susan D
SD
D000328:Adult; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007746:Labor Presentation; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth; D012189:Retrospective Studies