Safety of vaginal delivery in very low birthweight vertex singletons: a meta-analysis

The objective of this study is to assess the safety of vaginal delivery in VLBW singletons in the vertex presentation.

MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched for studies on mode of delivery and neonatal outcome in VLBW singletons in the vertex presentation. A total of 28 studies met our inclusion criteria.

Vaginal delivery was not associated with an increase in overall neonatal mortality compared with cesarean delivery (OR 0.87, 95% CI 0.72-1.04). Vaginal delivery was associated with a significant decrease in mortality for the 1250-1500 g birthweight category (OR 0.57, 95% CI 0.36-0.92), while an increase in mortality in the 500-750 g category was not significant (OR 1.5, 95% CI 0.86-2.61). Severe intraventricular hemorrhage (IVH) was not associated with mode of delivery (OR 1.05, 95% CI 0.85-1.29), but the only two high quality study that assessed IVH of all grades found an increase in risk for IVH in vaginal delivery (OR 1.33, 95% CI 1.16-1.51).

Vaginal delivery does not appear to increase the risk for neonatal mortality. However, current available data on neonatal morbidity are limited. More high-quality studies are needed to assess the association between mode of delivery and neonatal morbidity.