TY - JOUR
T1 - Safety of vaginal delivery in very low birthweight vertex singletons
T2 - a meta-analysis
AU - Barzilay, Eran
AU - Gadot, Yifat
AU - Koren, Gideon
N1 - Publisher Copyright:
© 2016 Taylor & Francis.
PY - 2016/11/16
Y1 - 2016/11/16
N2 - Objective: The objective of this study is to assess the safety of vaginal delivery in VLBW singletons in the vertex presentation. Methods: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched for studies on mode of delivery and neonatal outcome in VLBW singletons in the vertex presentation. A total of 28 studies met our inclusion criteria. Results: Vaginal delivery was not associated with an increase in overall neonatal mortality compared with cesarean delivery (OR 0.87, 95% CI 0.72–1.04). Vaginal delivery was associated with a significant decrease in mortality for the 1250–1500 g birthweight category (OR 0.57, 95% CI 0.36–0.92), while an increase in mortality in the 500–750 g category was not significant (OR 1.5, 95% CI 0.86–2.61). Severe intraventricular hemorrhage (IVH) was not associated with mode of delivery (OR 1.05, 95% CI 0.85–1.29), but the only two high quality study that assessed IVH of all grades found an increase in risk for IVH in vaginal delivery (OR 1.33, 95% CI 1.16–1.51). Conclusions: Vaginal delivery does not appear to increase the risk for neonatal mortality. However, current available data on neonatal morbidity are limited. More high-quality studies are needed to assess the association between mode of delivery and neonatal morbidity.
AB - Objective: The objective of this study is to assess the safety of vaginal delivery in VLBW singletons in the vertex presentation. Methods: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched for studies on mode of delivery and neonatal outcome in VLBW singletons in the vertex presentation. A total of 28 studies met our inclusion criteria. Results: Vaginal delivery was not associated with an increase in overall neonatal mortality compared with cesarean delivery (OR 0.87, 95% CI 0.72–1.04). Vaginal delivery was associated with a significant decrease in mortality for the 1250–1500 g birthweight category (OR 0.57, 95% CI 0.36–0.92), while an increase in mortality in the 500–750 g category was not significant (OR 1.5, 95% CI 0.86–2.61). Severe intraventricular hemorrhage (IVH) was not associated with mode of delivery (OR 1.05, 95% CI 0.85–1.29), but the only two high quality study that assessed IVH of all grades found an increase in risk for IVH in vaginal delivery (OR 1.33, 95% CI 1.16–1.51). Conclusions: Vaginal delivery does not appear to increase the risk for neonatal mortality. However, current available data on neonatal morbidity are limited. More high-quality studies are needed to assess the association between mode of delivery and neonatal morbidity.
KW - Intraventricular hemorrhage
KW - mode of delivery
KW - neonatal mortality
KW - perinatal outcome
KW - preterm delivery
UR - http://www.scopus.com/inward/record.url?scp=84959209420&partnerID=8YFLogxK
U2 - 10.3109/14767058.2016.1141889
DO - 10.3109/14767058.2016.1141889
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C2 - 26769191
AN - SCOPUS:84959209420
SN - 1476-7058
VL - 29
SP - 3724
EP - 3729
JO - Journal of Maternal-Fetal and Neonatal Medicine
JF - Journal of Maternal-Fetal and Neonatal Medicine
IS - 22
ER -