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[Method of delivery of premature infants--abdominal or vaginal?]
In regard to the present perinatal mortality for prematures with cephalic presentation, a general cesarian section below certain limits in weight and gestation cannot be recommended. The management of prematurity must be individualized and depends on additional risk factors. In case of doubt, the abdominal delivery is to prefer especially in a patient with less than 32 weeks of gestation or an estimated fetal weight of 1500 g or less. At least a potential risk for the fetus by anaesthesia and surgery has also to be considered. Vaginal delivery is justifiable especially in patients with unruptured membranes, high pelvic score and expected rapid delivery and with no additional fetal or maternal risk factors. Special attention must be paid to a gentle delivery of the head. These statements are based on present data of fetal mortality and probably of the same significance for fetal morbidity, especially the development of intraventricular hemorrhage.
In regard to the present perinatal mortality for prematures with cephalic presentation, a general cesarian section below certain limits in weight and gestation cannot be recommended. The management of prematurity must be individualized and depends on additional risk factors. In case of doubt, the abdominal delivery is to prefer especially in a patient with less than 32 weeks of gestation or an estimated fetal weight of 1500 g or less. At least a potential risk for the fetus by anaesthesia and surgery has also to be considered. Vaginal delivery is justifiable especially in patients with unruptured membranes, high pelvic score and expected rapid delivery and with no additional fetal or maternal risk factors. Special attention must be paid to a gentle delivery of the head. These statements are based on present data of fetal mortality and probably of the same significance for fetal morbidity, especially the development of intraventricular hemorrhage.