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Am J Perinatol 2015; 32(14): 1292-1297
DOI: 10.1055/s-0035-1562931
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Neonatal Outcomes by Mode of Delivery in Preterm Birth

Nathan R. Blue
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
,
Kristi R. Van Winden
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
,
Bhuvan Pathak
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
,
Lorayne Barton
2   Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
,
Neisha Opper
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
,
Christianne Joy Lane
3   Division of Biostatistics, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
,
Rangasamy Ramanathan
2   Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
,
Joseph G. Ouzounian
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
,
Richard H. Lee
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
› Author Affiliations
Further Information

Publication History

07 July 2015

07 July 2015

Publication Date:
07 September 2015 (online)

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Abstract

Objective We set out to test the hypothesis that infants born vaginally at ≤ 30 weeks gestation have less respiratory distress syndrome (RDS) than those born by cesarean delivery.

Study Design We conducted a retrospective cohort study of 652 infants born between 24 and 30 6/7 weeks gestation from March 31, 1996 to May 31, 2014. Comparisons of neonatal outcomes by intended and actual mode of delivery were made using chi-square and t-tests (α = 0.05). Multiple logistic regression was performed to control for confounding variables.

Results Neonates born by cesarean delivery were more likely to have RDS (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.10–2.90), require intubation (OR, 1.80; 95% CI, 1.12–2.88), and have longer neonatal intensive care unit stay (70.0 ± 37.1 vs. 57.3 ± 40.1 days, p = 0.02).

Conclusion Compared with cesarean delivery, vaginal delivery is associated with a significant reduction in RDS among infants born at ≤ 30 weeks gestation.

Keywords

cesarean delivery - preterm birth - preterm labor - respiratory distress syndrome - vaginal delivery
 

  • References

  • 1 MacDorman MF, Declercq E, Zhang J. Obstetrical intervention and the singleton preterm birth rate in the United States from 1991-2006. Am J Public Health 2010; 100 (11) 2241-2247
    CrossrefPubMedGoogle Scholar
  • 2 Matthews TJ, MacDorman MF. Infant mortality statistics from the 2010 period linked birth/infant death data set. Natl Vital Stat Rep 2013; 62 (8) 1-26
    PubMedGoogle Scholar
  • 3 Malloy MH, Onstad L, Wright E ; National Institute of Child Health and Human Development Neonatal Research Network. The effect of cesarean delivery on birth outcome in very low birth weight infants. Obstet Gynecol 1991; 77 (4) 498-503
    PubMedGoogle Scholar
  • 4 Arpino C, Brescianini S, Ticconi C , et al. Does cesarean section prevent mortality and cerebral ultrasound abnormalities in preterm newborns?. J Matern Fetal Neonatal Med 2007; 20 (2) 151-159
    CrossrefPubMedGoogle Scholar
  • 5 Haque KN, Hayes AM, Ahmed Z, Wilde R, Fong CY. Caesarean or vaginal delivery for preterm very-low-birth weight (< or =1,250 g) infant: experience from a district general hospital in UK. Arch Gynecol Obstet 2008; 277 (3) 207-212
    CrossrefPubMedGoogle Scholar
  • 6 Riskin A, Riskin-Mashiah S, Bader D , et al. Delivery mode and severe intraventricular hemorrhage in single, very low birth weight, vertex infants. Obstet Gynecol 2008; 112 (1) 21-28
    CrossrefPubMedGoogle Scholar
  • 7 Reddy UM, Zhang J, Sun L, Chen Z, Raju TNK, Laughon SK. Neonatal mortality by attempted route of delivery in early preterm birth. Am J Obstet Gynecol 2012; 207 (2) 117.e1-117.e8
    CrossrefPubMedGoogle Scholar
  • 8 Lee HC, Gould JB. Survival rates and mode of delivery for vertex preterm neonates according to small- or appropriate-for-gestational-age status. Pediatrics 2006; 118 (6) e1836-e1844
    CrossrefPubMedGoogle Scholar
  • 9 Muhuri PK, Macdorman MF, Menacker F. Method of delivery and neonatal mortality among very low birth weight infants in the United States. Matern Child Health J 2006; 10 (1) 47-53
    CrossrefPubMedGoogle Scholar
  • 10 Malloy MH. Impact of cesarean section on neonatal mortality rates among very preterm infants in the United States, 2000-2003. Pediatrics 2008; 122 (2) 285-292
    CrossrefPubMedGoogle Scholar
  • 11 Deulofeut R, Sola A, Lee B, Buchter S, Rahman M, Rogido M. The impact of vaginal delivery in premature infants weighing less than 1,251 grams. Obstet Gynecol 2005; 105 (3) 525-531
    CrossrefPubMedGoogle Scholar
  • 12 Malloy MH. Impact of cesarean section on intermediate and late preterm births: United States, 2000-2003. Birth 2009; 36 (1) 26-33
    CrossrefPubMedGoogle Scholar
  • 13 Werner EF, Savitz DA, Janevic TM , et al. Mode of delivery and neonatal outcomes in preterm, small-for-gestational-age newborns. Obstet Gynecol 2012; 120 (3) 560-564
    CrossrefPubMedGoogle Scholar
  • 14 Werner EF, Han CS, Savitz DA, Goldshore M, Lipkind HS. Health outcomes for vaginal compared with cesarean delivery of appropriately grown preterm neonates. Obstet Gynecol 2013; 121 (6) 1195-1200
    CrossrefPubMedGoogle Scholar
  • 15 Alfirevic Z, Milan SJ, Livio S. Caesarean section versus vaginal delivery for preterm birth in singletons. Cochrane Database Syst Rev 2013; 9 (6) CD000078
    PubMedGoogle Scholar
  • 16 Anderson GD, Bada HS, Shaver DC , et al. The effect of cesarean section on intraventricular hemorrhage in the preterm infant. Am J Obstet Gynecol 1992; 166 (4) 1091-1099 , discussion 1099–1101
    CrossrefPubMedGoogle Scholar
  • 17 Lee HC, Gould JB. Survival advantage associated with cesarean delivery in very low birth weight vertex neonates. Obstet Gynecol 2006; 107 (1) 97-105
    CrossrefPubMedGoogle Scholar
  • 18 Högberg U, Holmgren PA. Infant mortality of very preterm infants by mode of delivery, institutional policies and maternal diagnosis. Acta Obstet Gynecol Scand 2007; 86 (6) 693-700
    CrossrefPubMedGoogle Scholar
  • 19 Wylie BJ, Davidson LL, Batra M, Reed SD. Method of delivery and neonatal outcome in very low-birthweight vertex-presenting fetuses. Am J Obstet Gynecol 2008; 198 (6) 640.e1-640.e7 , discussion e1–e4
    CrossrefPubMedGoogle Scholar
  • 20 Hansen AK, Wisborg K, Uldbjerg N, Henriksen TB. Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study. BMJ 2008; 336 (7635) 85-87
    CrossrefPubMedGoogle Scholar
  • 21 Hemminki E, Meriläinen J. Long-term effects of cesarean sections: ectopic pregnancies and placental problems. Am J Obstet Gynecol 1996; 174 (5) 1569-1574
    CrossrefPubMedGoogle Scholar
  • 22 Nielsen TF, Hökegård KH. Cesarean section and intraoperative surgical complications. Acta Obstet Gynecol Scand 1984; 63 (2) 103-108
    PubMedGoogle Scholar