The Aim: Of this study is to determine the impact of the mode of delivery on survival, morbidity and prognosis of ELBW and extremely low gestational age (ELGA) newborns.
Methods: The retrospective review includes ELBW and ELGA infants born at the State maternity hospital "Maichin dom" Sofia from 1997 to 1999. These are 95 newborns divided into two groups: 31 born by Cesarean section (C. s.), and 64--per vias naturals (p. v. n.) with subgroups: 42--vertex, 22--breech delivery. Resuscitation is similar in all groups, according the routine practice. They are compared by the following indexes: rate of survival, Apgar scores at the 1-st and at the 5-th min, pH from the umbilical artery (u. a.), rate of the intraventricular hemorrhages (IVH) and periventricular leukomalacia (PVL), and early nevrodevelopmental outcome.
Results: The birth weight of all babies includes ranges from 500 to 999 g and the gestational age (g. a.) is > 24 weeks of gestation. There is no statistically significant difference (p < 0.05) according birth weight, pathology and treatment of the mother, between the two groups. In the C. s. group 17 babies survived (55%) while in p. v. n. 30 survived (47%), the worst was survival between the babies, delivered in breech presentation--7 (32%), p < 0.05. There is no significant difference between pH and BE from u. a., but Apgar scores are worse in the breech group, p < 0.05. The incidence of all grades IVH and PVL is almost the same, but there is a significant difference in the incidence of severe, grade 3 and 4 IVH and PVL (19% in C. s. group versus 48% p. v. n. group). The survivors with severe IVH are 57% among the breech delivered (p < 0.05) compared with respectively 33% and 26% among c. s. and vertex delivered groups. A CONCLUSION: Is made that C. s. provides better chances for a safe survival in ELBW and ELGA newborns and better prognosis for neurodevelopmental outcome. With the worst prognosis are the breech delivered ELBW babies.
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