Extremely preterm cesarean delivery:: a clinical study

Objectives. To describe indications for cesarean section for extremely preterm delivery, peri- and postoperative complications and perinatal outcome. Design. A case-referent study with clinical follow-up. Setting. A tertiary perinatal center. Population. All deliveries at gestational age <28 weeks at Umea University Hospital in 1997-2003. For preterm cesarean section referents were women with elective first-time term cesarean section. Methods. Indications for cesarean section delivery were assessed. Peri- and postoperative complications, asphyxia, and infant survival at discharge were described. Results. The cesarean section rate was 75%, in one third the operation was considered as difficult. Indications for extremely preterm abdominal delivery were severe disease during pregnancy and delivery complications. Six out of ten cesarean sections were performed on fetal indication. Nonisthmic incision was performed in 20% of cases. No major postoperative complications and few minor postoperative complications were noted. Irrespective of mode of delivery, few of the infants had severe asphyxia. Conclusion. In balancing the risks of complications related to the surgical procedure against the purported benefits of the infant, this study adds support to the argument to deliver even extremely preterm infants by cesarean section.