Navigation Links
Vaginal delivery as safe as cesarean for most early preterm births

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 contributors to indicated early preterm births. The study then evaluated 2,906 singleton pregnancies between 24 0/7 weeks and 31 6/7 weeks eligible for either route of delivery. Attempted vaginal delivery was compared to planned cesarean delivery. Data were analyzed based on gestational age blocks: 24 0/7 to 27 6/7 weeks and 28 0/8 to 31 67 weeks, based on the fact that the highest rates of neonatal mortality and morbidity occur 24 0/7 to 27 6/7 weeks.

Attempting vaginal delivery with vertex presentation at 24 0/7 to 27 6/7 weeks of gestation did not significantly affect neonatal mortality. More than 80% of the attempted vaginal births were successful. However, if the fetal presentation was breech, the majority of the deliveries were by planned cesarean delivery, and only 27.6% of attempted vaginal deliveries were successful.

Findings in the 28 0/7 to 31 6/7 weeks' gestation also differed by presentation. If the fetal presentation was vertex, the majority of attempted vaginal deliveries succeeded and there was no difference in the neonatal mortality rate compared with planned cesarean delivery. For breech-presenting fetuses, neonatal mortality was 6% for vaginal deliveries compared to 1.5% of the cesarean deliveries.

Dr. Reddy notes that previous studies examining the effect of route of delivery on neonatal mortality for early preterm births looked at the actual, not attempted, route of delivery. "The detailed information in our study, not available in birth certificate data, enabled us to account for the effect of attempted route of delivery and indications for delivery on neonatal mortality. This information has direct clinical applications and is crucial for counseling families about the benefit and risks of attempting vaginal delivery in this situation," she concludes.

Contact: Francesca Costanzo
Elsevier Health Sciences

Related medicine news :

1. Johnson & Johnson Violated FDA Order to Halt Sales of Transvaginal Mesh
2. US Drug Watchdog Launches Now Calls Transvaginal Mesh A Disaster For 100,000's of US Women Recipients And Offers The Names and Contacts Of The Best Women Attorneys
3. Internists express support for new payment and delivery models as basis for replacing SGR
4. Popularity Causing Several Week Lag In Delivery Of 'Plug In' Device To Start Saving On Electricity Between 8% and 20%
5. New delivery method improves efficacy of 2 common Parkinsons disease medications
6. UNC study shows potential to revive abandoned cancer drug by nanoparticle drug delivery
7. Normalizing tumor blood vessels improves delivery of only the smallest nanomedicines
8. Early treatment could mean greater earning potential for people with HIV
9. Scientists looking for noninvasive ways to detect lung cancer early
10. All HIV Patients Should Take Meds Early On, Experts Now Say
11. Dads Early Engagement With Son May Shape Behavior Later
Post Your Comments:
(Date:10/13/2017)... ... October 13, 2017 , ... Many families have long-term insurance that covers ... companies have a waiver for care if the client has a cognitive impairment diagnosis. ... pays for care, is often waived, so the benefits from their insurance start immediately,” ...
(Date:10/13/2017)... ... October 13, 2017 , ... Global Healthcare Management’s 4th Annual ... in Milford, NJ. This free event, sponsored by Global Healthcare Management’s CEO, Jon ... fun run is geared towards children of all ages; it is a non-competitive, non-timed ...
(Date:10/13/2017)... ... October 13, 2017 , ... Coveros, ... Development, has been awarded a contract by the Center for Medicare and Medicaid ... to accelerate the enterprise use of Agile methodologies in a consistent and high ...
(Date:10/12/2017)... Del. (PRWEB) , ... October 12, 2017 , ... ... and advisory services for healthcare compliance program management, will showcase a range of ... National Association for Assisted Living (NCAL) Convention and Expo to be held October ...
(Date:10/12/2017)... ... October 12, 2017 , ... The company has developed a ... and regulatory authorities worldwide. From Children’s to Adults 50+, every formula has been ... standard. , These products are also: Gluten Free, Non-GMO, Vegan, Soy Free, ...
Breaking Medicine News(10 mins):
(Date:10/11/2017)... 11, 2017  True Health, a leader in ... effort during National Breast Cancer Awareness month to ... Research recently ... that more than 10 million American women are ... BRCA1 or BRCA2 and have not had testing. These ...
(Date:10/7/2017)... 2017   Provista, a proven leader in ... in purchasing power, today announced a new resource area ... Newsroom is the online home for case studies, ... bios, news releases, slideshows and events. ... of resources at their fingertips, viewers can also watch ...
(Date:10/4/2017)... OBP Medical , a leading ... today announced regulatory approval from Brazil,s ... Nacional de Vigilância Sanitária (ANVISA)) to market ... with integrated LED light source and smoke evacuation ... of a tissue pocket or cavity during surgical ...
Breaking Medicine Technology: