Vaginal delivery may be superior to cesarean for preterm, SGA babies

Cesarean delivery of small for gestational age (SGA) preterm babies may not necessarily be more protective than vaginal delivery, according to the results of a study presented at the 2012 annual meeting of the Society for Maternal-Fetal Medicine, The Pregnancy Meeting, in Dallas, Texas (Abstract 13; presented February 9, 2012).

In fact, the authors of the study found that those babies delivered by cesarean were about 30% more likely to develop respiratory distress syndrome (odds ratio [OR], 1.3; 95% CI, 1.1-1.7) even after controlling for maternal age, ethnicity, education, primary payor, prepregnancy weight, gestational age at delivery, diabetes, and hypertension.

In addition, the babies delivered surgically were 40% more likely to have a 5-minute Apgar score of 7 than those delivered vaginally (OR, 1.4; 95% CI, 1.1-1.9), but this difference dissipated after adjusting for confounding factors.

Those neonates delivered vaginally were not at significantly higher risk for neonatal complications, and no significant differences were noted between the groups in the incidence of intraventricular hemorrhage, subdural hemorrhage, seizure, or sepsis.

Data from New York City during the period 1995-2003 were analyzed for 2,560 neonates weighing less than the 10th percentile at birth based on national growth curves and born more than 6 weeks before their due date. They included only singleton, live born, vertex neonates delivered between 25 and 34 weeks’ gestation; 46% were delivered vaginally and 54% were cesarean deliveries.

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