Cesarean delivery doesn’t protect small preemies

The opposite appears true: CD increases the risk of respiratory distress syndrome for preterm, small-for-gestational-age newborns

For preterm, small-for-gestational-age (SGA) neonates, cesarean delivery (CD) does not decrease neonatal complications, and is associated with an increased likelihood of respiratory distress syndrome (RDS), according to a study presented at the annual meeting of the Society for Maternal-Fetal Medicine (SMFM), held in February, in Dallas.

Erika F. Werner, MD, from Johns Hopkins University in Baltimore, and colleagues compared neonatal outcomes for preterm, SGA infants by method of delivery. Birth data were linked with hospital data for 2,560 singleton, live born, vertex neonates delivered between 25 and 34 weeks of gestation, from 1995 to 2003 in New York City.

The researchers found that 46% of neonates were delivered vaginally and 54% by CD. There were no significant between-group differences for intraventricular hemorrhage, subdural hemorrhage, seizure, or sepsis. Compared with vaginal delivery, for CD there were increased odds of RDS; this association persisted even after adjusting for confounding variables. Compared with vaginal delivery, for CD there were increased unadjusted odds of five-minute Apgar score of less than 7 (odds ratio, 1.4; 95% confidence interval, 1.1 to 1.9), but after adjustment the difference dissipated.

“CD was not associated with decreased odds of any neonatal complications and was associated with significantly higher odds of RDS in SGA preterm neonates,” the authors write.

The abstract is available at http://www.smfmnewsroom.org/annual-meeting/2011-meeting-abstracts/.

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