Philadelphia, PA, August 6, 2012 Vaginal delivery for early preterm fetuses presenting head first, or vertex presentation, had a high rate of success with no difference in neonatal mortality compared to cesarean delivery, a new study published in the American Journal of Obstetrics and Gynecology reports. For breech births, however, the failure rate of vaginal delivery was high and planned cesarean delivery was associated with significantly lower neonatal mortality.
"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," says lead investigator Uma M. Reddy, MD, MPH, of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD. "For vertex-presenting fetuses less than 32 weeks' gestation, we saw no improvement in neonatal mortality with a planned cesarean delivery."
Trials that attempt to randomize the route of delivery for women in preterm labor at high risk for delivery have not been feasible. Dr. Reddy and her colleagues used data from the Consortium on Safe Labor (CSL), a study conducted by the Eunice Kennedy Shriver National Institute of Child Health and Development, National Institutes of Health. The CSL is a retrospective study collecting extensive data on over 200,000 deliveries between 2002 and 2008 from 12 clinical centers and 19 hospitals across the country.
The investigators first categorized the indications for preterm delivery: preterm labor, preterm premature rupture of membranes (PPROM), or fetal/maternal issues such as preeclampsia, placental abruption, or severe maternal medical disease. Maternal or fetal indications were responsible for 45.7% of early preterm deliveries, PPROM for 37.7%, and preterm labor for 16.6%. Preeclampsia and major congenital anomalies were the leading
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Elsevier Health Sciences