title: Neonatal mortality by attempted route of delivery in early preterm birth.
abstract: OBJECTIVE
  We sought to study neonatal outcomes in early preterm births by delivery route.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  Attempted VD for vertex presentation has a high success rate with no difference in neonatal mortality unlike breech presentation.
authors: Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
authors: Uma M
authors: UM
authors: Reddy
authors: Jun
authors: J
authors: Zhang
authors: Liping
authors: L
authors: Sun
authors: Zhen
authors: Z
authors: Chen
authors: Tonse N K
authors: TN
authors: Raju
authors: S Katherine
authors: SK
authors: Laughon
mesh_terms: D000015:Abnormalities, Multiple / Q000453:epidemiology; D001238:Asphyxia Neonatorum / Q000401:mortality; D002543:Cerebral Hemorrhage / Q000401:mortality; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007746:Labor Presentation; D015999:Multivariate Analysis; D007752:Obstetric Labor, Premature / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D047928:Premature Birth; D014219:Trial of Labor