Maternal and Neonatal Outcomes in Trial of Vaginal Delivery Versus Cesarean Section in Preterm Pregnancies

Background and objectives: A trial of labor after cesarean is a vital strategy to reduce neonatal morbidity associated with cesarean section. Thus, this study aimed to compare the effects of planned cesarean and vaginal delivery on neonatal outcomes in preterm pregnancies. Methods: This prospective observational study was conducted on 100 pregnant women with previous cesarean section at Sulaimani Maternity Teaching Hospital from May 2022 to May 2023. Patients’ data with neonatal outcomes were collected and the correlation between the mode of delivery and various causes (preterm vaginal birth to preterm planned cesarean) was determined. Results: The maternal age, using steroids during pregnancy, and antenatal care not affected the delivery mode (p=0.195, p=0.517, and 0.16, respectively). In contrast, gestational age (p=0.02), past medical history (p=0.05), and causes of delivery (p=0.037) significantly was affecting the delivery mode. Additionally, fetal morbidity (p=0.806) and appearance/pulse/grimace/activity/and respiration score (p=0.509) were not related to delivery modality. The leading cause of fetus admission to the neonate intensive care unit in both groups was respiratory distress syndrome (n=43), followed by sepsis (n=14), while the leading causes of neonatal death in both groups was sepsis (n=10) and respiratory distress syndrome (n=6) (p≥0.05). Conclusions: The mode of delivery is affected by gestational age, past medical history, and delivery causes. Respiratory distress syndrome and sepsis were the leading causes of neonatal admission to the intensive care unit, and sepsis with respiratory distress syndrome was the leading cause of neonatal death.