Mode of delivery and outcomes in preterm births.

OBJECTIVE

To compare maternal and neonatal outcomes by mode of delivery in preterm births.

METHODS

This prospective study was a part of SEA-ORCHID project of 9,263 pregnant women. The subjects were all women admitted for preterm birth (20 to 36 weeks) in nine hospitals in four Southeast Asian countries (Thailand, Malaysia, Indonesia, and the Philippines) between June 2007 and December 2009. Deliveries were classified into vaginal delivery and caesarean delivery. We obtained data from women's medical and delivery records.

RESULTS

There were 765 preterm births in this analysis, 294 (38.4%) were delivered by caesarean section with a mean weight of 1,988 +/- SD 629 g and 471 (61.6%) were delivered vaginally with a mean weight of 1,982 +/- SD 699 g. There were two maternal deaths in caesarean delivery group. Caesarean delivery was significantly associated with increased risk of blood loss > 500 ml and > 1,000 ml, adjusted ORs: 11.7, CI 95%: 5.7-24.1 and 12.0, CI 95%: 2.2-65.3, respectively. Infants delivered vaginally had a significantly shorter length of hospital stay than infant delivered by caesarean delivery (adjusted mean difference 3.4, CI 95%: 1.2-5.5). The risk of respiratory distress syndrome, birth asphyxia (low Apgar scores (< 7) at 5 minutes) and early neonatal death were not statistically different between caesarean delivery and vaginal delivery.

CONCLUSIONS

In preterm births, caesarean delivery significantly increases the risk of postpartum hemorrhage and had longer neonatal length of hospital stay compared to vaginal delivery.