Cesarean delivery before term - neonatal and pediatric aspects

Area of Science:

• Obstetrics and Gynecology
• Neonatal Medicine
• Perinatal Epidemiology

Background:

• Cesarean delivery is a common birth route for preterm infants, but its benefits and harms remain unclear.
• Epidemiological data and neonatal outcomes related to delivery mode in preterm infants are crucial for clinical practice.
• Understanding associations between preterm cesarean delivery and later child health is important.

Purpose of the Study:

• To review the epidemiology of preterm cesarean delivery globally.
• To analyze neonatal outcomes based on delivery mode in various preterm birth scenarios.
• To discuss the association between preterm cesarean delivery and long-term child health.

Main Methods:

• Systematic review of international collaboration data on preterm cesarean delivery rates.
• Analysis of neonatal outcomes across four obstetrical scenarios: cephalic/noncephalic presentations, preeclampsia, and multiple pregnancies.
• Brief discussion on long-term child health associations.

Main Results:

• Cesarean delivery rates for preterm births vary significantly by country and gestational age, reaching 66% in very preterm and 58% in moderately preterm births in Europe.
• For low-risk cephalic singleton births, cesarean delivery is linked to higher neonatal respiratory morbidity.
• Preterm cesarean delivery for breech presentation is associated with lower neonatal mortality, especially in very preterm infants.

Conclusions:

• Routine cesarean delivery for preterm infants is not supported by evidence, except for breech presentation, emergencies, and monoamniotic twins.
• Medical indications often justify cesarean delivery in very/extremely preterm gestations, prioritizing immediate survival benefits.
• Unnecessary cesarean deliveries in moderate-late preterm births could potentially be reduced.