[Mortality and morbidity of small premature infants (<1,500 g) in relation to presentation and delivery mode].

It is generally recommended in the literature that small premature babies with an expected weight of < 1500 g or < 32 WOP be delivered by cesarean section. The development of some of these small babies from the uterine muscle is very time-consuming and rough. For this reason, we have established the mode of the delivery at the Nuremberg Women's Hospital on the basis of the criteria which also applies to the delivery of mature term babies irrespective of the gestational age and irrespective of their presentation. Of a total number of 10542 babies delivered, 219 babies < 1500 g in weight (2.07%) were born from 1987 to 1991. The extent to which differences in the mode of deliveries spontaneous/cesarean section result from the presentation of the small premature babies was investigates after five years. The mortality and morbidity were calculated separately for babies the weighing between 1500 g and 1000 g and for babies of < or = 999 g. Besides the perinatal and neonatal mortality, the mortality after the 29th day of life was also determined. The following parameters of early morbidity were established: 1. Respiratory distress syndrome++ (none/grade I-grade IV) 2. Intracranial hemorrhages (none/grade I-grade IV) Furthermore, the following parameters of late infant morbidity were determined after the first year of life. 1. Movement capacity (normal/hyperkinetic/apathic) 2. Development of the baby (corresponding to age/ slightly/severely retarded) Severely retarded fetuses with a gestational age of more than 32 weeks and a birth rate of < 1500 g were excluded from all calculations, so that ultimately 176 babies were included in the overall analysis. The total mortality of the children < 1500 g in weight was 14.3%, 15.7% were in the group between 1500 g and 1000 g and 25% were the mortality with regard to the presentation and the mode of delivery. The morbidity results indicate that only the group of babies between 1500 g and 1000 g in weight with breech presentation benefit from cesarean section. In the group of babies < or = 999 g, there are no differences in morbidity with regard to the mode of delivery and the presentation. The results found show that frequencies of cesarean section in excess of 40% improve neither the mortality nor the morbidity of small premature babies. The decision to carry out cesarean section is based more on individual influences and the situation in the hospital in which the delivery takes place than on mortality of the baby or the mother.