The Impact Of Mode Of Delivery (Vaginal Delivery Versus Caesarean Section) On Outcome In Premature Births < 32 Weeks Of Gestation In Vertex Presentation

Purpose and Method: The aim of the study was to analyse the impact of Caesarean section on the neonatal outcome of 328 premature infants delivered before 32 weeks' gestation.Results: The total neonatal mortality rate was 46/328 (14%). After the exclusion of patients with confounding factors (malformation, abortion, admission during the third stage of labour, emergency Caesarean section) 277 deliveries were evaluated further (140 vaginal, 137 Caesarean sections). The mortality Fate was 12/277 (4.3%). Vaginal and Caesarean deliveries showed no difference in neonatal mortality (4.3% vs. 4.4%), intraventricular haemorrhage (25% vs. 23.4%), and trauma (7.8% vs. 12.4%). Subependydimal haemorrhage (19.3% vs. 31.4%; p < 0.03), low Apgar scores (less than or equal to 7) at 5 minutes (7.9% vs. 16.1%; p < 0.05), severe respiratory distress syndrome (RDS III-IV: 17.8% vs. 43.8%; p < 0.001) and ensuing artificial Ventilation (50.6% vs. 61.7%; p < 0.05) was significantly more common after Caesarean section than after vaginal delivery.Conclusion: We conclude that Caesarean section per se provides no benefit for premature infants at < 32 weeks' gestation. Accordingly, the indications far the procedure should be strict. For judging the mode of delivery in breech presentation this study is not appropriate since only 3 such cases at 24, 29, and 31 weeks were delivered vaginally. All three offspring were doing well.