The impact of mode of delivery on neonatal outcome in preterm births

To evaluate the impact of mode of delivery on the outcome of neonates born before 34 weeks of gestation.

This is a retrospective cohort study of all singleton live neonates born between 24.1 and 34.0 weeks of gestation at our institute between January 2009 and July 2017. Maternal and pregnancy characteristics, as well as the neonatal outcome, were compared between vaginal delivery (VD) and cesarean delivery (CD).

Of 475 preterm births, 223 (46.9%) were delivered vaginally and 252 (53.1%) were delivered by CD. Women who delivered vaginally were younger, (29.6 ± 6 versus 31.2 ± 6 years, p = .003), had lower rate of hypertensive disorders (9.9 versus 36.1%, p < .001), and diabetes mellitus (0.4 versus 4.4%, p = .006), and had higher rate of drug abuse (4.9 versus 1.6%, p = .006), as compared to those who delivered by CD. Neonates who were born by VD had higher birth weight (1716 ± 595 versus 1443 ± 507, p < .001) and a lower rate of Small for gestational age (7.2 versus 19.4%, p < .001) than those who were born by CD. Although VD neonates had higher Apgar score, as compared with CD, the neonatal composite outcome was similar between the two modes of deliveries. These findings were consistent in subgroups analysis according to gestational age (GA). By logistic regression analysis, only the administration of betamethasone up to 1 week prior to delivery (aOR = 0.59, 95% CI 0.38-0.92, p = .001) and GA at delivery (aOR = 0.74 95% CI 0.64-0.84, p = .004) were found to be independently protective against composite neonatal outcome.

It seems that neonatal outcome is not affected by the mode of delivery.