Mode of delivery in pregnancies complicated by preeclampsia with very low birth weight infants.

The aims of this study were to examine data from an institution at which the goal has been to pursue vaginal delivery in patients with a preterm gestation and preeclampsia and to test the hypothesis that labor does not increase the risk of poor outcome for the preterm infant of a mother with preeclampsia. An analysis of all singleton infants born live who weighed 1500 gm or less and who were born to mothers with preeclampsia or eclampsia from 1975 to 1990 was undertaken. The infants who were delivered by cesarean section without labor and with a reassuring fetal assessment were compared with the infants who went through labor. Of 116 women with singleton pregnancies with preeclampsia and an infant who weighed 1500 gm or less, 54.3% were delivered by cesarean section without labor, 31.0% because of nonreassuring fetal assessment and 23.3% (group 1) because of other indications. Of the patients allowed to labor (group 2), 47.2% had cesarean sections because of fetal intolerance of labor and 32.1% were delivered vaginally. Of the patients who were delivered vaginally, 75% had an unfavorable Bishop's score at the outset of the induction. There was no significant difference between groups 1 and 2 for a number of immediate and long-term outcome variables except for a lower incidence of respiratory distress syndrome in the infants who went through labor. On the basis of these limited data a trial of labor should be considered in carefully selected women with preeclampsia who have very-low-birth-weight infants.