Study offers reassurance over premature births

Nation.Cymru staff

How very premature babies are born may make little difference to their risk of death or serious brain injury, according to new research.

The Cardiff University-led study analysed data from more than 74,000 very preterm births across England and Wales, comparing babies born vaginally with those delivered by caesarean section.

Babies born before 32 weeks face an increased risk of death and brain injury, including intraventricular haemorrhage (IVH), or bleeding in the brain.

But the PRECIOUS study, funded by Health and Care Research Wales, found no strong evidence that caesarean delivery reduced the risk of death or severe IVH once other factors were taken into account.

Researchers said the findings should reassure families and clinicians that decisions can generally be made according to the circumstances of the individual mother and baby rather than favouring one method of delivery.

There was some evidence that the baby’s position could make a difference, with caesarean section potentially offering a benefit for babies in the breech position.

Dr David Odd, consultant neonatologist and senior lecturer at Cardiff University, led the study.

He said: “There are so many factors at play when it comes to deciding whether to deliver a baby by caesarean section or vaginally. Things can be even more complicated when the baby is very premature.

“Historically, clinicians have not had enough evidence to show the effects of a policy of one mode of delivery over the other. Many research teams have tried to answer that question over the years but to put it simply, nobody knows.

“By modelling what an effective RCT would look like, we found that even if we did manage to recruit the tens of thousands of mothers to such a study, the difference in outcomes still wouldn’t reliably indicate prioritising one mode of birth over the other in most cases.

“Being able to take this one particular factor out of the decision process may help to reassure families and clinicians that they can continue to make the best decision based on each individual mother and baby’s circumstances.”

The study has been published in The Journal of Maternal-Fetal and Neonatal Medicine.

Jane, from Cardiff, was a patient representative and co-applicant on the research after giving birth to identical twin sons Ayrton and Bevan at 30 weeks by emergency caesarean section.

The twins shared a placenta and Ayrton had reduced blood flow which affected his growth. After his condition deteriorated, doctors decided the babies needed to be delivered.

Ayrton weighed 780g and spent 13 weeks in neonatal intensive care at the University Hospital of Wales, while Bevan, who weighed 1.3kg, spent seven weeks there.

The twins are now 22.

‘Rewarding’

Jane said: “Even 22 years ago I realised how important medical research was to their survival and healthy outcome. It has been very rewarding to use my experience and be just a small part of ongoing research around pre-term birth.

“Pregnancy is such an anxious time and going into premature labour or being aware that your baby or babies might be delivered early just exacerbates this.

“Mothers will want to know that the mode of birth, where there is an option, will be the most appropriate for them and their baby.

“The results of this research seem to suggest that mode of birth may make little difference in most preterm babies. The decision-making process can focus on other factors affecting the mother and baby and be centred on them.”

Janet Scott, head of the Saving Babies’ Lives team at pregnancy and baby loss charity Sands, said the research offered reassurance to families and clinicians dealing with premature birth.

She said: “This latest evidence will mean that mothers and birthing people, together with healthcare professionals, can focus on informed choice and personal preference, knowing that the way the baby is born does not affect the outcome.”

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