Home Medicine Mode of delivery and adverse short- and long-term outcomes in vertex-presenting very preterm born infants: a European population-based prospective cohort study
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Mode of delivery and adverse short- and long-term outcomes in vertex-presenting very preterm born infants: a European population-based prospective cohort study

  • Hanne Trap Wolf ORCID logo EMAIL logo , Tom Weber , Stephan Schmidt , Mikael Norman , Heili Varendi , Aurélie Piedvache , Jennifer Zeitlin , Lene Drasbek Huusom and EPICE Research Group
Published/Copyright: July 20, 2021
Journal of Perinatal Medicine
From the journal Journal of Perinatal Medicine Volume 49 Issue 7

Abstract

Objectives

To compare mortality, morbidity and neurodevelopment by mode of delivery (MOD) for very preterm births with low prelabour risk of caesarean section (CS).

Methods

The study was a population-based prospective cohort study in 19 regions in 11 European countries. Multivariable mixed effects models and weighted propensity score models were used to estimate adjusted odds ratios (aOR) by observed MOD and the unit’s policy regarding MOD. Population: Singleton vertex-presenting live births at 24 + 0 to 31 + 6 weeks of gestation without serious congenital anomalies, preeclampsia, HELLP or eclampsia, antenatal detection of growth restriction and prelabour CS for fetal or maternal indications.

Results

Main outcome measures: A composite of in-hospital mortality and intraventricular haemorrhage (grade III/IV) or periventricular leukomalacia. Secondary outcomes were components of the primary outcome, 5 min Apgar score <7 and moderate to severe neurodevelopmental impairment at two years of corrected age. The rate of CS was 29.6% but varied greatly between countries (8.0–52.6%). MOD was not associated with the primary outcome (aOR for CS 0.99; 95% confidence interval [CI] 0.65–1.50) when comparing units with a systematic policy of CS or no policy of MOD to units with a policy of vaginal delivery (aOR 0.88; 95% CI 0.59–1.32). No association was observed for two-year neurodevelopment impairment for CS (aOR 1.15; 95% CI 0.66–2.01) or unit policies (aOR 1.04; 95% CI 0.63–1.70).

Conclusions

Among singleton vertex-presenting live births without medical complications requiring a CS at 24 + 0 to 31 + 6 weeks of gestation, CS was not associated with improved neonatal or long-term outcomes.

Keywords: caesarean section; mode of delivery; preterm birth; vertex presentation; very preterm infants
Corresponding author: Hanne Trap Wolf, MD, PhD, Department of Gynaecology and Obstetrics, Hvidovre University Hospital, Kettegaard Alle 30, 2650 Hvidovre, Denmark, Phone: +0045 38623862, E-mail:

Funding source: European Union’s Seventh Framework Programme (FP7/2007–2013)

Award Identifier / Grant number: 259882

Funding source: French Institute of Public Health Research/Institute of Public Health and its partners the French Health Ministry, the National Institute of Health and Medical Research, the National Institute of Cancer, and the National Solidarity Fund for Autonomy

Funding source: National Research Agency through the French Equipex Program of Investments in the Future

Award Identifier / Grant number: ANR-11-EQPX-0038

Funding source: PremUp Foundation

Funding source: Polish Ministry of Science and Higher Education

Funding source: Foundation for Science and Technology – FCT (Portuguese Ministry of Science, Technology and Higher Education)

Funding source: Neonatal Networks for East Midlands and Yorkshire & Humber regions

Acknowledgments

We would like to acknowledge the participation of the Departments of Obstetrics and Neonatology from the hospitals in the EPICE regions. EPICE (Effective Perinatal Intensive Care in Europe) Research Group, collaborators: Belgium: Flanders (E Martens, G Martens, P Van Reempts); Denmark: Eastern Region (K Boerch, A Hasselager, LD Huusom, O Pryds, T Weber); Estonia (L Toome, H Varendi); France: Burgundy, Ile-de France and Northern Region (PY Ancel, B Blondel, A Burguet, PH Jarreau, P Truffert); Germany: Hesse (RF Maier, B Misselwitz, S Schmidt), Saarland (L Gortner); Italy: Emilia Romagna (D Baronciani, G Gargano), Lazio (R Agostino, D DiLallo, F Franco), Marche (V Carnielli), M Cuttini; Netherlands: Eastern & Central (C Koopman-Esseboom, A van Heijst, J Nijman); Poland: Wielkopolska (J Gadzinowski, J Mazela); Portugal: Lisbon and Tagus Valley (LM Graça, MC Machado), Northern region (Carina Rodrigues, T Rodrigues), H Barros; Sweden: Stockholm (AK Bonamy, M Norman, E Wilson); UK: East Midlands and Yorkshire and Humber (E Boyle, ES Draper, BN Manktelow), Northern Region (AC Fenton, DWA Milligan); INSERM, Paris (J Zeitlin, M Bonet, A Piedvache). Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, France.

  1. Research funding: The EPICE project was funded from the European Union’s Seventh Framework Programme (FP7/2007–2013) under grant agreement no. 259882. Additional funding was received for the EPICE project in the following regions: France (French Institute of Public Health Research/Institute of Public Health and its partners the French Health Ministry, the National Institute of Health and Medical Research, the National Institute of Cancer, and the National Solidarity Fund for Autonomy; grant ANR-11-EQPX-0038 from the National Research Agency through the French Equipex Program of Investments in the Future; and the PremUp Foundation); Poland (2012–2015 allocation of funds for international projects from the Polish Ministry of Science and Higher Education); Portugal (by FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology – FCT (Portuguese Ministry of Science, Technology and Higher Education), under the Unidade de Investigação em Epidemiologia – Instituto de Saúde Pública da Universidade do Porto); UK (funding for The Neonatal Survey from Neonatal Networks for East Midlands and Yorkshire & Humber regions).

  2. Author contributions: HTW participated in the study design, drafted the initial manuscript and approved the final manuscript as submitted. TW, SS, MN, HV, and LDH contributed to the study design, reviewed and revised the manuscript, and approved the final manuscript as submitted. JZ designed and conceptualised the study, conducted the data analysis, reviewed and revised the manuscript and approved the final manuscript as submitted. JZ had full access to all study data and take responsibility for the integrity of the data and the accuracy of the analyses. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: Ethics approval was obtained in each study region from regional and/or hospital ethics committees, as required by national legislation. The European study was also approved by the French Advisory Committee on Use of Health Data in Medical Research (No. 13.020 on 24/01/2013) and the French National Commission for Data Protection and Liberties (DR-2013-194, on 10/04/2013).

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Received: 2020-10-06
Accepted: 2021-03-14
Published Online: 2021-07-20
Published in Print: 2021-09-27

© 2021 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Introduction to the cesarean section articles
  4. Highlight Section: Cesarean Section
  5. Three kinds of caesarean sections: the foetal/neonatal perspective
  6. The neonatal respiratory morbidity associated with early term caesarean section – an emerging pandemic
  7. Vaginal birth after cesarean (VBAC): fear it or dare it? An evaluation of potential risk factors
  8. Nationwide implementation of a decision aid on vaginal birth after cesarean: a before and after cohort study
  9. Induction of labor at 39 weeks and risk of cesarean delivery among obese women: a retrospective propensity score matched study
  10. Cervical ripening after cesarean section: a prospective dual center study comparing a mechanical osmotic dilator vs. prostaglandin E2
  11. An evidence-based cesarean section suggested for universal use
  12. Online survey on uterotomy closure techniques in caesarean section
  13. Analysis of cesarean section rates in two German hospitals applying the 10-Group Classification System
  14. Reviews
  15. Pregnancy in incarcerated women: need for national legislation to standardize care
  16. Imaging diagnosis and legal implications of brain injury in survivors following single intrauterine fetal demise from monochorionic twins – a review of the literature
  17. Mini Review
  18. Professionally responsible management of the ethical and social challenges of antenatal screening and diagnosis of β-thalassemia in a high-risk population
  19. Opinion Paper
  20. Teaching and training the total percutaneous fetoscopic myelomeningocele repair
  21. Corner of Academy
  22. Chronic hypertension in pregnancy: synthesis of influential guidelines
  23. Original Articles
  24. The effects of pre-pregnancy obesity and gestational weight gain on maternal lipid profiles, fatty acids and insulin resistance
  25. Determination of organic pollutants in meconium and its relationship with fetal growth. Case control study in Northwestern Spain
  26. Betamethasone as a potential treatment for preterm birth associated with sterile intra-amniotic inflammation: a murine study
  27. Diagnostic accuracy of modified Hadlock formula for fetal macrosomia in women with gestational diabetes and pregnancy weight gain above recommended
  28. Vasa previa: when antenatal diagnosis can change fetal prognosis
  29. Mode of delivery and adverse short- and long-term outcomes in vertex-presenting very preterm born infants: a European population-based prospective cohort study
  30. Short Communication
  31. Reference ranges for sphingosine-1-phosphate in neonates
https://doi.org/10.1515/jpm-2020-0468
Keywords for this article
caesarean section; mode of delivery; preterm birth; vertex presentation; very preterm infants

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Introduction to the cesarean section articles
  4. Highlight Section: Cesarean Section
  5. Three kinds of caesarean sections: the foetal/neonatal perspective
  6. The neonatal respiratory morbidity associated with early term caesarean section – an emerging pandemic
  7. Vaginal birth after cesarean (VBAC): fear it or dare it? An evaluation of potential risk factors
  8. Nationwide implementation of a decision aid on vaginal birth after cesarean: a before and after cohort study
  9. Induction of labor at 39 weeks and risk of cesarean delivery among obese women: a retrospective propensity score matched study
  10. Cervical ripening after cesarean section: a prospective dual center study comparing a mechanical osmotic dilator vs. prostaglandin E2
  11. An evidence-based cesarean section suggested for universal use
  12. Online survey on uterotomy closure techniques in caesarean section
  13. Analysis of cesarean section rates in two German hospitals applying the 10-Group Classification System
  14. Reviews
  15. Pregnancy in incarcerated women: need for national legislation to standardize care
  16. Imaging diagnosis and legal implications of brain injury in survivors following single intrauterine fetal demise from monochorionic twins – a review of the literature
  17. Mini Review
  18. Professionally responsible management of the ethical and social challenges of antenatal screening and diagnosis of β-thalassemia in a high-risk population
  19. Opinion Paper
  20. Teaching and training the total percutaneous fetoscopic myelomeningocele repair
  21. Corner of Academy
  22. Chronic hypertension in pregnancy: synthesis of influential guidelines
  23. Original Articles
  24. The effects of pre-pregnancy obesity and gestational weight gain on maternal lipid profiles, fatty acids and insulin resistance
  25. Determination of organic pollutants in meconium and its relationship with fetal growth. Case control study in Northwestern Spain
  26. Betamethasone as a potential treatment for preterm birth associated with sterile intra-amniotic inflammation: a murine study
  27. Diagnostic accuracy of modified Hadlock formula for fetal macrosomia in women with gestational diabetes and pregnancy weight gain above recommended
  28. Vasa previa: when antenatal diagnosis can change fetal prognosis
  29. Mode of delivery and adverse short- and long-term outcomes in vertex-presenting very preterm born infants: a European population-based prospective cohort study
  30. Short Communication
  31. Reference ranges for sphingosine-1-phosphate in neonates
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