Mode of Delivery and Outcomes in Preterm Births
Ussanee Sangkomkamhang MD*, Porjai Pattanittum MSc**, Malinee Laopaiboon PhD**, Pisake Lumbiganon MD***
Affiliation : * Department of Obstetrics and Gynecology, Khon Kaen Hospital, Khon Kaen, Thailand ** Department of Biostatistics and Demography, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand *** Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Objective : To compare maternal and neonatal outcomes by mode of delivery in preterm births.
Material and Method: 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 hospitalss 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.
Conclusion : In preterm births, caesarean delivery significantly increases the risk of postpartum hemorrhage and had longer
neonatal length of hospital stay compared to vaginal delivery.
Keywords : Maternal outcomes, Mode of delivery, Neonatal outcomes, Preterm births
