Vital Signs

Support for vaginal preterm deliveries

A large study has found that even very preterm babies can be safely delivered vaginally, provided they are not in the breech position.

An analysis of 2,906 babies born at 24 to 32 weeks’ gestation found no difference in neonatal deaths of vertex (headfirst) babies whether the mother attempted a vaginal delivery or had a Caesarean section. But with breech babies, the study found, a C-section is significantly safer.

Among 714 women with very preterm vertex babies  –  24 to 28 weeks of gestation  –  77 per cent attempted a vaginal delivery, and 84 per cent of them succeeded. Neonatal mortality was 15.2 per cent, compared with 13.5 per cent for a planned C-section, a difference that could be due to chance. But among mothers of babies in a breech presentation, only 27.6 per cent who attempted a vaginal delivery were successful, and vaginal delivery was linked to a neonatal death rate almost twice as high as that of planned C-sections.

The study, published in the August issue of the American Journal of Obstetrics & Gynecology, controlled for factors like age, alcohol and drug use and smoking..

“C-sections at these early ages of gestation are associated with increased rates of complication,” said the lead author, Dr Uma M Reddy, an obstetrician with the National Institutes of Health. “If you need to be delivered at less than 32 weeks and the baby is head-down, attempting vaginal delivery has a high success rate.”

Nicolas Bakalar
NYTNS