The association between mode of delivery and severe intraventricular hemorrhage in very preterm infants

Infants born before 32 weeks of gestation are at high risk of developing intraventricular hemorrhage (IVH), which is associated with significant mortality and morbidity as well as long-term neurodevelopmental impairment. There is currently a lack of consensus regarding the impact of delivery mode on these infants. Therefore, the aim of this study was to determine the association between mode of delivery and the incidence of severe intraventricular hemorrhage (sIVH) in very to extremely preterm infants born before 32 weeks of gestation.

This retrospective cohort study was conducted at the University Hospital Zurich, Switzerland, using integrated obstetric and neonatal databases. Live births born between 23 + 0 and 31 + 6 weeks from 2015 to 2023 were included. Confounders were selected a priori based on a direct acyclic graph, and severe IVH incidence was compared between vaginal and cesarean delivery using univariable and multivariable logistic regression models.

A total of 683 infants were eligible for analysis. The proportion of children born by cesarean section was 77.5%. The incidence of sIVH in preterm infants delivered by cesarean section was 4.7% compared to 3.9% in vaginal deliveries. The univariable logistic regression analysis demonstrated no significant association between cesarean section and sIVH (OR 1.32, 95% CI 0.53-3.28, p = 0.529).

In this cohort of very and extremely preterm infants, there was no significant association between the incidence of severe IVH and mode of delivery. These findings do not support cesarean sections as a preventive measure for sIVH and highlight the importance of optimizing pre-, peri-, and postnatal factors that impact haemodynamic stability.