Vaginal delivery as safe as cesarean for most early preterm births
Vaginal delivery for early preterm fetuses presenting head first, or vertex presentation, had a high rate of success with no difference in neonatal mortality compared to cesarean delivery, a new study published in the American Journal of Obstetrics and Gynecology reports. For breech births, however, the failure rate of vaginal delivery was high and planned cesarean delivery was associated with significantly lower neonatal mortality.
"Selecting a route of delivery at less than 32 weeks' gestation is a difficult clinical decision given the high rate of infant mortality and morbidity as well as the maternal risks associated with cesarean delivery," says lead investigator Uma M. Reddy, MD, MPH, of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD. "For vertex-presenting fetuses less than 32 weeks' gestation, we saw no improvement in neonatal mortality with a planned cesarean delivery."
Trials that attempt to randomize the route of delivery for women in preterm labor at high risk for delivery have not been feasible. Dr. Reddy and her colleagues used data from the Consortium on Safe Labor (CSL), a study conducted by the Eunice Kennedy Shriver National Institute of Child Health and Development, National Institutes of Health. The CSL is a retrospective study collecting extensive data on over 200,000 deliveries between 2002 and 2008 from 12 clinical centers and 19 hospitals across the country.
The investigators first categorized the indications for preterm delivery: preterm labor, preterm premature rupture of membranes (PPROM), or fetal/maternal issues such as preeclampsia, placental abruption, or severe maternal medical disease. Maternal or fetal indications were responsible for 45.7% of early preterm deliveries, PPROM for 37.7%, and preterm labor for 16.6%. Preeclampsia and major congenital anomalies were the leading contributors to indicated early preterm births. The study then evaluated 2,906 singleton pregnancies between 24 0/7 weeks and 31 6/7 weeks eligible for either route of delivery. Attempted vaginal delivery was compared to planned cesarean delivery. Data were analyzed based on gestational age blocks: 24 0/7 to 27 6/7 weeks and 28 0/8 to 31 67 weeks, based on the fact that the highest rates of neonatal mortality and morbidity occur 24 0/7 to 27 6/7 weeks.
Attempting vaginal delivery with vertex presentation at 24 0/7 to 27 6/7 weeks of gestation did not significantly affect neonatal mortality. More than 80% of the attempted vaginal births were successful. However, if the fetal presentation was breech, the majority of the deliveries were by planned cesarean delivery, and only 27.6% of attempted vaginal deliveries were successful.
Findings in the 28 0/7 to 31 6/7 weeks' gestation also differed by presentation. If the fetal presentation was vertex, the majority of attempted vaginal deliveries succeeded and there was no difference in the neonatal mortality rate compared with planned cesarean delivery. For breech-presenting fetuses, neonatal mortality was 6% for vaginal deliveries compared to 1.5% of the cesarean deliveries.
Dr. Reddy notes that previous studies examining the effect of route of delivery on neonatal mortality for early preterm births looked at the actual, not attempted, route of delivery. "The detailed information in our study, not available in birth certificate data, enabled us to account for the effect of attempted route of delivery and indications for delivery on neonatal mortality. This information has direct clinical applications and is crucial for counseling families about the benefit and risks of attempting vaginal delivery in this situation," she concludes.
More information: Neonatal Mortality by Attempted Route of Delivery in Early Preterm Birth by U.M Reddy, J. Zhang, L. Sun, Z. Chen, T.N.K. Raju, and S.K. Laughon (doi 10.1016/j.ajog.2012.06.023.), American Journal of Obstetrics & Gynecology, Volume 207, Issue 2 (August)
Provided by Elsevier
- Study finds in women with prior cesarean, optimal gestational age for elective delivery is week 39 Feb 10, 2012 | not rated yet | 0
- Repeat C-section before 39 weeks raises risk of neonatal illness Jan 07, 2009 | not rated yet | 0
- Researchers pinpoint reasons for dramatic rise in C-sections Jun 22, 2011 | not rated yet | 0
- Study able to predict which cesarean births could cause uterine rupture Jan 30, 2009 | not rated yet | 0
- Vaginal progesterone reduces preterm birth, neonatal morbidity and mortality in women at risk Dec 14, 2011 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
The Durability of Bone: Long Falls
1 hour ago I am doing a paper on the physics in Valve's Portal and got interested in the "Long Fall Boots" that prevent any damage no matter how far you fall. I...
Is energy convertible to matter?
3 hours ago Can we convert energy to matter?
Rotating electron as a dipole is this right?
5 hours ago An electron as shown by the Stern Gerlach experiment behaves like a dipole (albeit only in one of two states). I have been trying to figure out how...
Dipole term in multipole expansion
9 hours ago Hi. I'm having some difficult in understanding something about the dipole term in a multipole expansion. Griffiths writes the expansion as a sum of...
Bubbles in a Pre-Boiling/Boiling pot of water
11 hours ago How is it that bubbles form on the bottom of a surface of a pot of boiling water? I think that there is probably an elementary answer to this...
Assumptions of Griffith's fracture theory
21 hours ago Any experts on Griffith's fracture theory? I am studying the subject and I am having hard time finding out if the theory is valid for all possible...
- More from Physics Forums - Classical Physics
More news stories
A study of around 1,000 UK mothers and their children, published in The Lancet, has revealed that iodine deficiency in pregnancy may have an adverse effect on children's mental development. The research raises concerns that t ...
Obstetrics & gynaecology 5 hours ago | not rated yet | 0
Nearly three out of four pregnant women experience constipation, diarrhea or other bowel disorders during their pregnancies, a Loyola University Medical Center study has found.
Obstetrics & gynaecology May 20, 2013 | not rated yet | 0
New research indicates that women's reproductive function may be tied to their immune status. Previous studies have found this association in human males, but not females.
Obstetrics & gynaecology May 17, 2013 | not rated yet | 0 |
Elsevier today announced the publication of a recent study in Reproductive BioMedicine Online on 5-day old human blastocysts showing that those with an abnormal chromosomal composition can be identified by the rate at whic ...
Obstetrics & gynaecology May 16, 2013 | not rated yet | 0
While global attention has for decades been focused on reducing maternal mortality, population-based data on other causes of death among women of reproductive age has been virtually non-existent. A study conducted by researchers ...
Obstetrics & gynaecology May 14, 2013 | not rated yet | 0
(Medical Xpress)—Native peoples in regions where cameras are uncommon sometimes react with caution when their picture is taken. The fear that something must have been stolen from them to create the photo ...
12 hours ago | 4.2 / 5 (5) | 0 |
(Medical Xpress)—Despite spending billions of dollars on research and development, drug companies have been unable to come up with effective treatments for dementia and Alzheimer's Disease (AD). Now, A. ...
10 hours ago | 4.9 / 5 (9) | 0 |
Activating an enzyme known to play a role in the anti-aging benefits of calorie restriction delays the loss of brain cells and preserves cognitive function in mice, according to a study published in the May ...
6 hours ago | 5 / 5 (3) | 0 |
An experimental sleeping pill from US drug company Merck is effective at helping people fall and stay asleep, according to reviewers at the US Food and Drug Administration, which could soon approve the new drug.
5 hours ago | 3 / 5 (2) | 0
Australian scientists have charted the path of insulin action in cells in precise detail like never before. This provides a comprehensive blueprint for understanding what goes wrong in diabetes.
12 hours ago | 4.4 / 5 (5) | 0 |
A drug commonly used to treat depression and anxiety may improve a stress-related heart condition in people with stable coronary heart disease, according to researchers at Duke Medicine.
7 hours ago | 5 / 5 (1) | 0 |