Vaginal delivery for early preterm foetuses who present head first, or vertex, have the same high rate of success — with no difference in neonatal mortality — as a caesarean delivery. That’s according to a new study published in the American Journal of Obstetrics and Gynaecology.
However, the failure rate of vaginal delivery was high for breech births, and planned caesarean 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.”
According to the findings
More than 80% of vaginal births were successful with vertix presentation at 24 0/7 to 27 6/7 weeks of gestation. 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.
According to Dr. reddy, “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.