[Effect of mode of delivery on early morbidity and mortality of premature infants (< or = 34th week of pregnancy)]

Abstract

In a retrospective analysis (1985-1994) the influence of the mode of delivery on mortality and early morbidity of low birth weight infants (< or = 2500 gm and < or = 34 weeks of gestation) was assessed (n = 450). We only included cases that offered a choice between abdominal and vaginal delivery (cephalic and breech presentation, premature rupture of membranes and preterm labour). We found significantly higher survival rates in infants with birth weights of 1500 gm or less in case of breech and cephalic presentation after cesarean births. In infants with cephalic presentation and birth weights of 1500 gm or less no parameter of early morbidity was changed by the mode of delivery. Infants with breech presentation and birth weights of 1500 gm or less have less severe cerebral hemorrhages, cord pH values < or = 7.15 and have a lower incidence of primary intubation after abdominal delivery. Infants with birth weights of 1501-2500 gm and cephalic presentation are better off after a vaginal delivery, because there is the same survival rate and some parameters of early morbidity (1' and 5' Apgar score, incidence of primary intubation) are better after spontaneous births. In breech infants with birth weights of 1501-2500 gm there are no differences in mortality and early morbidity after vaginal and abdominal birth. A logistic regression analysis showed, that the risk of dying was significantly higher in infants with cerebral hemorrhages (I degree-IV degrees) and in infants born before 1990. In infants with birth weights of 1500 gm or less the mortality rate was higher after vaginal delivery and in case of an 10' Apgar score <8. Regarding infants with birth weights of 1501-2500 gm the risk of dying was higher in infants that suffered from a respiratory distress syndrome I degree-IV degrees and in case of birth weights of 2000 gm or less.