The influence of mode of birth on neonatal survival and maternal outcomes at extreme prematurity: a retrospective cohort study

Thomas, Penelope E., Petersen, Scott G. and Gibbons, Kristen (2016) The influence of mode of birth on neonatal survival and maternal outcomes at extreme prematurity: a retrospective cohort study. Australian and New Zealand Journal of Obstetrics and Gynaecology, 56 1: 60-68. doi:10.1111/ajo.12404


Author Thomas, Penelope E.
Petersen, Scott G.
Gibbons, Kristen
Title The influence of mode of birth on neonatal survival and maternal outcomes at extreme prematurity: a retrospective cohort study
Journal name Australian and New Zealand Journal of Obstetrics and Gynaecology   Check publisher's open access policy
ISSN 1479-828X
0004-8666
Publication date 2016-02-01
Year available 2015
Sub-type Article (original research)
DOI 10.1111/ajo.12404
Open Access Status Not Open Access
Volume 56
Issue 1
Start page 60
End page 68
Total pages 9
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing
Language eng
Formatted abstract
Background: There is a paucity of published clinical data to guide obstetric decision-making regarding mode of birth at extreme prematurity.
Aims: To evaluate whether neonatal survival or maternal outcomes were affected by the decision to perform a caesarean section (CS) between 23 + 0 and 26 + 6 weeks' gestation.
Materials and Methods: A single-centre retrospective cohort study of all liveborn infants born with a plan for active resuscitation at 23–26 weeks' gestation was performed. Descriptive and multivariate logistic regression analyses compared outcomes after vaginal birth and CS. Subgroup analyses of nonfootling breech presentations, multiple pregnancies and singleton pregnancies in spontaneous preterm labour were performed.
Results: Outcomes for 625 neonates delivered by 540 mothers were analysed. A total of 300 (48%) neonates were born vaginally and 325 (52%) by CS. Mode of birth was not associated independently with survival for any multivariate analysis; gestational age at birth was an independent predictor across all analyses. Adverse maternal outcomes were documented in 112 (21%) pregnancies; the rate of severe maternal complications was low. Maternal morbidity was not affected by mode of birth.
Conclusions: Mode of birth did not affect neonatal survival or the rate of maternal morbidity for deliveries at 23–26 completed weeks' gestation.
Keyword Caesarean section
Extremely preterm infant
Neonatal prematurity
Perinatal mortality
Preterm birth
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes Published online 22 September 2015

Document type: Journal Article
Sub-type: Article (original research)
Collections: Mater Research Institute-UQ (MRI-UQ)
Non HERDC
School of Nursing, Midwifery and Social Work Publications
 
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Created: Thu, 31 Mar 2016, 22:13:20 EST by Kristen Gibbons on behalf of Learning and Research Services (UQ Library)