Safety of vaginal delivery in very low birthweight vertex singletons: a meta-analysis

Eran Barzilay, Yifat Gadot, Gideon Koren

Research output: Contribution to journalReview articlepeer-review

10 Scopus citations


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.

Original languageEnglish
Pages (from-to)3724-3729
Number of pages6
JournalJournal of Maternal-Fetal and Neonatal Medicine
Issue number22
StatePublished - 16 Nov 2016
Externally publishedYes


  • Intraventricular hemorrhage
  • mode of delivery
  • neonatal mortality
  • perinatal outcome
  • preterm delivery


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