The influence of mode of birth on neonatal survival and maternal outcomes at extreme prematurity: A retrospective cohort study

Thomas, Penelope E.; Petersen, Scott; Gibbons, Kristen

doi:10.1111/ajo.12404

Cited by 14 publications

(27 citation statements)

References 25 publications

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“…If it was not stated in the primary study ( n = 46), we contacted authors to determine outcomes for actively resuscitated infants, by gestational age or birthweight, and information on standard use of antenatal corticosteroids if before the 1994 guidelines (Figure ). We included a total of 15 studies, from the USA (3), France (2), England, Italy, Sweden, Germany, Turkey, Canada, Australia, Trinidad and Tobago, Hungary and Romania, with a total of 12 335 infants (see Table S1).…”

Section: Resultsmentioning

confidence: 99%

What is the safest mode of birth for extremely preterm breech singleton infants who are actively resuscitated? A systematic review and meta‐analyses

Grabovac

Karim

Isayama

et al. 2017

BJOG

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Section: Resultsmentioning

confidence: 99%

What is the safest mode of birth for extremely preterm breech singleton infants who are actively resuscitated? A systematic review and meta‐analyses

Grabovac

Karim

Isayama

et al. 2017

BJOG

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“…In extremely preterm twins, prior to 1994 and hence advent of antenatal corticosteroid therapy and other advances in neonatal management, some studies had found a decrease in the risk of mortality with caesarean section in second twins weighing 601–999 g [ 66 ] and those weighing less than 1000 g [ 67 ]. More recently, Thomas 2016 [ 68 ] found an increase in survival with caesarean section for multiples from 24 to 26 weeks’ gestation presenting as non-footling breech, but that difference was no longer significant after adjustment for gestational age, chorioamnionitis and maternal age. This study did not stratify data by birth order, and included higher order multiples.…”

Section: Discussionmentioning

confidence: 99%

What is the safest mode of delivery for extremely preterm cephalic/non-cephalic twin pairs? A systematic review and meta-analyses

Dagenais

Lewis-Mikhael

Grabovac

et al. 2017

BMC Pregnancy Childbirth

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BackgroundGiven the controversy around mode of delivery, our objective was to assess the evidence regarding the safest mode of delivery for actively resuscitated extremely preterm cephalic/non-cephalic twin pairs before 28 weeks of gestation.MethodsWe searched Cochrane CENTRAL, MEDLINE, EMBASE and http://clinicaltrials.gov from January 1994 to January 2017. Two reviewers independently screened titles, abstracts and full text articles, extracted data and assessed risk of bias. We included randomized controlled trials and observational studies. Our primary outcome was a composite of neonatal death (<28 days of life) and severe brain injury in survivors (intraventricular hemorrhage grade ≥ 3 or periventricular leukomalacia). We performed random-effects meta-analyses, generating odds ratios with 95% confidence intervals for the first and second twin separately, and for both twins together. We assessed the risk of bias using a modified Newcastle Ottawa Scale (NOS) for observational studies and used Grading of Recommendations Assessment, Development and Evaluation approach (GRADE).ResultsOur search generated 2695 articles, and after duplicate removal, we screened 2051 titles and abstracts, selecting 113 articles for full-text review. We contacted 36 authors, and ultimately, three observational studies met our inclusion criteria. In cephalic/non-cephalic twin pairs delivered by caesarean section compared to vaginal birth at 24+0–27+6 weeks the odds ratio for our composite outcome of neonatal death and severe brain injury for the cephalic first twin was 0.35 (95% CI 0.00–92.61, two studies, I2 = 76%), 1.69 for the non-cephalic second twin (95% CI 0.04–72.81, two studies, I2 = 55%) and 0.83 for both twins (95% CI 0.05–13.43, two studies, I2 = 56%). According to the modified Newcastle Ottawa Scale we assessed individual study quality as being at high risk of bias and according to GRADE the overall evidence for our primary outcomes was very low.ConclusionOur systematic review on the safest mode of delivery for extremely preterm cephalic/non-cephalic twin pairs found very limited existing evidence, without significant differences in neonatal death and severe brain injury by mode of delivery.Electronic supplementary materialThe online version of this article (10.1186/s12884-017-1554-7) contains supplementary material, which is available to authorized users.

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“…Similarly, cohort studies of foetal deliveries before the 26th week of gestation do not indicate that caesarean sections significantly improve the survival of newborns [32,33]. Caesarean sections in pregnancies before 26 weeks have been shown to be a risk factor for complications in subsequent pregnancies.…”

Section: Non-cephalic Fetal Presentationmentioning

confidence: 99%

Recommendations of the Polish Society of Gynecologists and Obstetricians regarding caesarean sections

et al. 2018

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The influence of mode of birth on neonatal survival and maternal outcomes at extreme prematurity: A retrospective cohort study

Abstract: Mode of birth did not affect neonatal survival or the rate of maternal morbidity for deliveries at 23-26 completed weeks' gestation.

Cited by 14 publications

References 25 publications

What is the safest mode of birth for extremely preterm breech singleton infants who are actively resuscitated? A systematic review and meta‐analyses

What is the safest mode of birth for extremely preterm breech singleton infants who are actively resuscitated? A systematic review and meta‐analyses

What is the safest mode of delivery for extremely preterm cephalic/non-cephalic twin pairs? A systematic review and meta-analyses

Recommendations of the Polish Society of Gynecologists and Obstetricians regarding caesarean sections

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