Neonatal morbidity and mortality by mode of delivery in very
There are many reasons for cesarean delivery (CD) in extremely preterm and very preterm infants, including labor, fetal distress, maternal indications, and malpresentation.

This study aimed to determine whether CD is associated with significantly improved neonatal morbidity.

This study is a retrospective cohort study of all singleton pregnancies delivered at 22.0 – 29.0 weeks gestation admitted for preterm labor (PTL) or preterm premature rupture of membranes (PPROM), excluding neonates with a delivery weight ≤ of 500 grams, multiple gestations, intrauterine fetal demise, and induction terminations.

The primary outcome for the study was a neonatal morbidity composite (APGAR < 5 at 5 min, prolonged ventilation (>28 days), intraventricular hemorrhage, necrotizing enterocolitis, coagulopathy, discharged on home ventilator support, or discharged with an enteric feeding tube). CD was performed for standard obstetric indications. There were 271 eligible deliveries, 128 cesarean deliveries, and 143 vaginal deliveries.

- The CD group had fewer nulliparous patients and more fetuses that presented breaches at the time of delivery. Overall composite neonatal morbidity occurred in 202/271 of deliveries and mortality occurred in 7/271 of deliveries.

- When adjusting for nulliparity, delivery year, and fetal presentation at the time of delivery, the CD was associated with decreased risk of death in the delivery room or within 24 hours of delivery.

- CD was also associated with increased use of exogenous surfactant and bag-mask ventilation and In a secondary analysis looking only at patients receiving a complete course of steroids, there were no differences in composite morbidity or mortality.

In particular, CD performed for standard obstetric indications in very preterm neonates is associated with a decreased risk of death in the delivery room or within 24 hours of delivery but is not associated with improvement in morbidity or mortality overall.

American Journal of Obstetrics & Gynecology