Trial of Labor and Neonatal Outcomes in Extreme prematurity <28 Weeks' Gestation

BACKGROUND The optimal mode of delivery for extremely preterm infants remains a subject of debate, particularly concerning the potential benefits of planned cesarean delivery. OBJECTIVE This study aimed to compare adverse neonatal outcomes between planned cesarean delivery and a trial of labor for singleton infants born before 28 weeks of gestation. STUDY DESIGN We conducted a retrospective cohort study of all singleton pregnancies delivered between 24 ^0/7 and 27 ^6/7 weeks of gestation at a single university-affiliated tertiary medical center. Patients were categorized into two groups: patients who opted a trial of vaginal delivery (TOL group) and those who had planned cesarean delivery (CD group). The primary outcome included neonatal death before discharge and severe neurological injury. Postnatal outcomes were recorded during hospitalization before discharge, and data were analyzed using an intention-to-treat analysis. Additional sub-analyses included women with spontaneous onset of labor without maternal or neonatal delivery indications and those within the gestational age range of 25 ^0/7 to 27 ^6/7 weeks. RESULTS A total of 199 patients were eligible for inclusion: 64 opted a trial of vaginal delivery (TOL group), while 135 underwent planned cesarean delivery (CD group). Within the TOL group, there was a higher incidence of delivery at 24 ^0/7 - 24 ^6/7 weeks of gestation. Five women (7.8%) in the TOL group underwent intrapartum urgent CD. No disparities in the rates of primary or overall composite outcomes were observed between the TOL and CD groups (26.6% vs. 31.9%, p = 0.448 and 85.9% vs. 90.4%, p = 0.352, respectively). Adjusted multivariate analysis did not find significance between a trial of labor or planned cesarean delivery. CONCLUSIONS In extreme preterm births between 24–28 weeks of gestation no difference was found for the risk for adverse neonatal outcomes between those who had a trial of labor and those who underwent planned cesarean delivery.