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.

中文翻译：

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早产儿的分娩方式和不良的短期和长期结果：一项基于欧洲人群的前瞻性队列研究

目的 比较剖宫产 (CS) 低产前风险的极早产的分娩方式 (MOD) 的死亡率、发病率和神经发育。方法 该研究是一项基于人群的前瞻性队列研究，在 11 个欧洲国家的 19 个地区进行。多变量混合效应模型和加权倾向评分模型用于通过观察到的 MOD 和单位关于 MOD 的政策来估计调整优势比 (aOR)。人群：妊娠 24 + 0 至 31 + 6 周的单胎顶点活产，没有严重的先天性异常、先兆子痫、HELLP 或子痫、产前检测生长受限和产前 CS 的胎儿或母体适应症。结果 主要结果测量：住院死亡率和脑室内出血（III/IV 级）或脑室周围白质软化的复合。次要结局是主要结局的组成部分，5 分钟 Apgar 评分 <7 和矫正年龄 2 岁时的中度至重度神经发育障碍。CS 的发生率为 29.6%，但各国之间差异很大（8.0-52.6%）。MOD 与主要结果（CS 的 aOR 0.99；95% 置信区间 [CI] 0.65-1.50）在比较系统性 CS 政策或无 MOD 政策的单位与阴道分娩政策的单位（aOR 0.88 ; 95% CI 0.59–1.32)。没有观察到 CS（aOR 1.15；95% CI 0.66-2.01）或单位政策（aOR 1.04；95% CI 0.63-1.70）的两年神经发育障碍。结论 在妊娠 24 + 0 至 31 + 6 周时需要进行 CS 的单胎顶点活产中，CS 与新生儿或长期结局的改善无关。