Skip to main content

Advertisement

Log in

Caesarean or vaginal delivery for preterm very-low-birth weight (≤1,250 g) infant: experience from a district general hospital in UK

  • Original Article
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

To determine whether delivery by caesarean is associated with a better neuro-developmental outcome at two years for preterm infants born weighing 1,250 g or less.

Setting

District General Hospital, United Kingdom.

Design

All inborn infants weighing <1,250 g born at St Helier University Hospital between January 1995 and December 2003 were identified from contemporaneously collected computer database. All hospital records were retrieved. Details of the mother, delivery route, Apgar score, details of resuscitation and details of the baby, neonatal progress and neuro-developmental status at two years was transcribed on a pre-designed proforma. Neuro-developmental status assessment at two years of age was carried out by an independent neurodevelopmental paediatrician. Neuro-developmental status was classified as normal, severe, moderate or mild disability.

Statistical analysis

Analysis was done by creating a simple two by two table. Statistical significance was set at p = 0.05. Multivariate and univariate analysis was carried out for a number of confounding variables.

Sample

Total of 411 babies were identified from the data-base. Of these 59 were still born and fourteen though born alive died in the delivery suit. 125 (37%) were excluded from analysis as they were returned to their referring hospitals prior to discharge from hospital. Information about their two-year follow-up was either incomplete or not robust enough to be included in the analysis. Analysis was carried out on 213(63%) for whom we had complete data set at two years of age (103 infants born via vaginal delivery and 110 infants were born by caesarean section).

Outcome measure

Primary outcome measure was to compare survival at discharge and neurodevelopmental status at two years of age of this cohort. Secondary outcome included determining the incidence of grade III or IV intraventricular haemorrhage (IVH), chronic lung disease and necrotising enterocolitis (NEC).

Results

The overall caesarean delivery rate for this cohort was 51.6% while the overall caesarean rate for all births at our hospital during the study period varied between 20 and 23%. Neonatal mortality for those delivered by caesarean was 12.7% compared to 14.5% for those delivered vaginally (p = ns). Overall incidence of any neuro-disability at two years of age was 46.8% for those delivered by caesarean compared to 47.7% for those delivered vaginally (p = ns). There was no difference in those with severe (23.5% vs. 25.0%), moderate (10.4% vs. 9%) or mild (12.5% vs. 13.6%) neuro-disability between the groups nor was there any difference in the number of babies with IVH, chronic lung disease and NEC. Neuro-disability was equally greater in both groups for babies born weighing 750 grams or less and/or born at 26 weeks or less gestation.

Conclusion

Despite the increasing tendency to deliver extremely preterm babies by caesarean, we did not find that it was associated with either reduced mortality or neuro-disability at two years of age. Therefore the method of delivery of very-low-birth weight premature infants should be based on obstetric or maternal indications rather than the perceived outcome of the baby.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Paul RH, Koh KS, Monfared AH (1979) Obstetric factors influencing outcome in infants weighing 1001 to 1500 grams. Am J Obstet Gynecol 133:503–508

    PubMed  CAS  Google Scholar 

  2. Bottoms SF, Paul RH, Iams JD, et al (1997) Obstetric determinants of neonatal survival: influence of willingness to perform caesarean delivery on survival of extremely low-birth-weight infants. Am J Obstet Gynecol 176:960–966

    Article  PubMed  CAS  Google Scholar 

  3. Suidan JS, Sayegh RA (1998) Delivery of the low birth weight and very low birth weight breech: caesarean section or vaginal delivery? J Perinatal Med 17:145–149

    Article  Google Scholar 

  4. Redman ME, Gonik B (2002) Caesarean delivery rates at the threshold of viability. Am J Obstet Gynecol 187:873–876

    Article  PubMed  Google Scholar 

  5. Malloy MH, Oustad L, Wright E (1991) The effect of caesarean delivery on birth outcome in very low-birth weight infants. Obstet Gynecol 77:498–503

    PubMed  CAS  Google Scholar 

  6. Anderson GD, Bada HS, Sibai BM, et al (1998) The relationship between labour and route of delivery in preterm infants. Am J Obstet Gynecol 58:1382–1390

    Google Scholar 

  7. Wadhawan R, Vohr BR, Fanaroff AA, et al (2003) Does labour influence neonatal and neuro-developmental outcomes of extremely low-birth weight infants who are born by caesarean delivery? Am J Obstet Gynecol 189:501–506

    Article  PubMed  Google Scholar 

  8. Grobe E, Chasen S, Harmath A, et al (1997) Very low birth weight breech infants: short-term outcome by method of delivery. J Maternal Fetal Med 6:155–158

    Article  Google Scholar 

  9. Jonas HA, Khalid N, Schwartz SM (1999) The relationship between caesarean section and neonatal mortality in very-low birth weight infants born in Washington State, USA. Paediat Perinatal Epidemiol 13:170–189

    Article  CAS  Google Scholar 

  10. Wolf H, Schaap AH, Bruinse HW, et al (1999) Vaginal delivery compared with caesarean section in early preterm breech delivery: a comparison of long-term outcome. Br J Obstet Gynecol 106:486–491

    CAS  Google Scholar 

  11. Penn ZJ, Steer P, Grant A (1996) A multi centre randomised controlled trial comparing elective and selective caesarean section for delivery of preterm breech infants. Br J Obstet Gynecol 103:684–689

    CAS  Google Scholar 

  12. Grant A, Penn ZJ, Steer P (1996) Elective or selective caesarean section delivery of the small baby? Systemic review of controlled trials. Br J Obstet Gynecol 103:1197–2000

    CAS  Google Scholar 

  13. Wallace RL, Schifirm BS, Paul RH (1984) The delivery route for very low-birth-weight infants. J Reproductive Med 29:736–740

    CAS  Google Scholar 

  14. Kitchen W, Ford GW, Doyle LW, et al (1985) Caesarean section or vaginal delivery at 24 to 28 weeks gestation. Comparison of survival and neonatal and two year morbidity. Obstet Gynecol 66:149–157

    PubMed  CAS  Google Scholar 

  15. Marlow N, Wolke D, Bracewell MA, Samara M, EPICure study group: (2005) Neurologic and developmental disability at six years of age after extremely preterm births. NEJM Jan 6:352(1):9–19

    Google Scholar 

  16. Lumley J (2003) Method of delivery for the preterm infant. Br J Obstet Gynecol 110:88–92

    Google Scholar 

  17. Grant A (2002) Elective versus selective caesarean section for delivery of the small baby. Cohrane Database Systemic Review Issue; 2

  18. Mcelrath TF (2004) Caesarean delivery at the limits of viability. Clinical Obstet Gynecol 47(2):342–351

    Article  Google Scholar 

  19. Rosen MG, Dickinson JC, Westhoff CL (1991) Vaginal birth after caesarean: meta-analysis of mortality and morbidity. Obstet Gynecol 77:465–472

    PubMed  CAS  Google Scholar 

  20. Nielson TF, Hokegard KH (1984) Caesarean section and intra-operative surgical complications. Acta Obstet Gynecol Scand 63:103–111

    Article  Google Scholar 

  21. Fanaroff AA, Hack M, Walsh MC (2003) The NICHD neonatal research network: changes in practice and outcomes during the first 15 years. Semin Perinatol 27:281–287

    Article  PubMed  Google Scholar 

  22. Weissman A, Blazer S, Zimmer EZ, et al (1988) Low birth weight breech infant: short-term and long-term outcome by method of delivery. Am J Perinatol 5:289–292

    Article  PubMed  CAS  Google Scholar 

  23. Myers S, Gleicher NG (1987) Breech delivery: Why the dilemma? Am J Obstet Gynecol 156:6–10

    PubMed  CAS  Google Scholar 

  24. Macdonald H (2002) American college of pediatrics: perinatal care at the threshold of viability. Pediatrics 110:1024–1051

    Article  PubMed  Google Scholar 

  25. American College of Obstetricians and Gynaecologists. Perinatal Care at the threshold of viability (2002). ACOG: Practice Bulletin. No:38

  26. Riskin A, Riskin-Mashiah S, Lusky A, Richman B (2004) The relationship between delivery mode and mortality in very low birth weight singleton vertex presenting infants. Br J Obstet Gynecol 14:1365–1371

    Google Scholar 

  27. Deulofeut R, Sola A, Lee B, et al (2005) The impact of vaginal delivery in premature infants weighing less than 1251 grams. Obstet Gynecol 105:523–531

    Google Scholar 

  28. Lee HC, Gould JB (2006) Survival advantage associated with caesarean delivery in very low birth weight vertex neonates. Obstet Gynecol 107:97–105

    PubMed  Google Scholar 

Download references

Acknowledgement

We are very grateful to Dr. Ruth Shephard, Consultant Neonatologist for reviewing the manuscript and advice.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Khalid N. Haque.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Haque, K.N., Hayes, AM., Ahmed, Z. et al. Caesarean or vaginal delivery for preterm very-low-birth weight (≤1,250 g) infant: experience from a district general hospital in UK. Arch Gynecol Obstet 277, 207–212 (2008). https://doi.org/10.1007/s00404-007-0438-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-007-0438-x

Keywords

Navigation