OPTIMIZING THE DELIVERY METHOD FOR EXTREMELY PREMATURE BIRTHS
Authors: Bila V. , Zahorodnia O. , Tsapenko T. 
Published: November 2024

The contemporary classifi cation of premature birth is predicated on the condition of the newborn, encompassing the severity of respiratory disorders, morpho- functional immaturity, prognosis for survival, and long-term consequences. In accordance with these criteria, newborns with a gestational age of up to 28 weeks are classifi ed as extremely premature, given the inherently challenging nature of their weaning process. This article presents the dynamics of early neonatal mortality and lethality indicators in cases of vaginal and abdominal delivery. This article presents an analysis of contemporary global trends in the selection of delivery methods for premature births and extremely premature pregnancies.The aim of the study. To propose a modifi ed approach to the choice of delivery method in pregnant women in the gestational period of 24-28 weeks.Research materials and methods. The analysis was conducted on 350 cases of extremely premature singleton births (within 24-28 weeks) that occurred at the Perinatal Center of Kyiv between 2019 and 2023. A comparison of the early neonatal mortality rate of newborns with a gestational age of 24-28 weeks was conducted, stratifi ed by the method of delivery. The relative risk of mortality during the fi rst seven days and throughout the fi rst year of life, contingent on the method of delivery, was calculated. Furthermore, the frequency of the most common complications of the neonatal period in newborns with extremely low body weight was analyzed, and the relative risk of their development was calculated depending on the method of delivery. The Foster- Stewart test was employed to substantiate the statistical reliability of the obtained results. The two average indicators are then compared with one another using the Student’s test. A value of ≤0.05 indicates statistically signifi cant changes in the indicator’s dynamics. The research was carried out within the framework of the implementation of scientifi c topics of the Department of Obstetrics and Gynecology No. 1 of the Bogomolets National Medical University: Research work «Preservation and restoration of women’s reproductive health in conditions of rapid medical and social changes» implementation period 01.01.2023-12.2024. Research results and their discussion. An analysis of the dynamics of early neonatal mortality in the category of 24-28 gestationalweeks from 2019 to 2023 was conducted, identifying several factors. These included the active implementation of intranatal magnesium therapy and improvements in the quality of neonatal care at the technical level. As evidenced by the data, the rate of early neonatal mortality in very early premature births reached 43.3 % in 2019, declining to 25.5 % by 2022. In the 2019-2020 period, 50 % of neonatal deaths occurring within the fi rst seven days were infants born by caesarean section. The ratio of vaginal births to births by caesarean section in gestational periods up to 28 weeks is approximately 2:1. In addition to the observed reduction in the rate of early neonatal mortality, a two-fold decrease was noted in the rate among children born by caesarean section. The mortality rate of extremely premature infants, despite a gradual decline, remains relatively high, at approximately 34.2 % in 2023. Our fi ndings, based on the expansion of indications for caesarean section rather than its routine use in preterm birth, indicate that the relative risk of neonatal death before seven days for vaginal delivery compared with caesarean section, calculated with a 95 % confi dence interval, was 2.65. Similarly, the calculated riskof mortality during the fi rst year of life is 1.34. With regard to intraventricular hemorrhage, the relative risk was 3.12, indicating that the route of delivery in this cohort of newborns exerts an infl uence on the frequency of the complication. The risk of hemorrhagic syndrome is 0.97, which does not provide suffi cient evidence to suggest that it can be prevented by selecting an abdominal delivery. The proportion of abdominal deliveries at the Perinatal Center has remained relatively stable since the expansion of indications for premature births, with a slight increase from 14.2 % in 2019 to 15.2 % in 2023. This was accomplished through a logical and evidence- based approach to caesarean section in full-term pregnancies.Conclusions. 1.From 2019 to 2023, a notable decline was observed in the incidence of early neonatal mortality (from 43.3 to 23.6 %) and child mortality (from 61.3 % to 34.2 %) among newborns with a gestational age of up to 28 weeks. 2. The incidence of early neonatal mortality up to 28 weeks is lower among newborns delivered by caesarean section than among those delivered vaginally. 3. The optimization of perinatal indicators is contingent upon an individualized approach to the selection of a delivery method for pregnant women with premature rupture of the membranes up to 28 weeks.