Mode of delivery in the low birth weight fetus. Delivery by cesarean section independent of fetal lie versus vaginal delivery in vertex presentation. A study with long-term follow-up.

In a paired controlled multicenter study of patients in preterm labor of unknown etiology without additional maternal or fetal complications, 59 low birth weight infants in vertex presentation born vaginally were compared with 59 infants delivered by cesarean section. In the early postpartum period, hypothermia and acidosis occurred more often in the vaginal delivery group. The rate of respiratory disorders and need for assisted ventilation did not differ between the groups. Persistent ductus arteriosus occurred in 19% in the vaginal delivery group and in 7% in the abdominal delivery group. At follow-up until 18-24 months of age the rate of cerebral palsy did not differ between the groups, whereas the rate of psychomotor retardation was significantly higher in the vaginal delivery group (p less than 0.05). The difference in percentage of total outcome, i.e. sum of mortality and neurodevelopmental sequelae, being 20.3% in the vaginal delivery group versus 8.5% in the cesarean section group, fails to reach a statistical significance, but the results suggest that for the low birth weight infants, vaginal delivery may be more hazardous than abdominal delivery.