Relation between perinatal factors and outcome of very low birth weight infants.

In order to better understand the effect of obstetric management on the prognosis of very low birth weight (VLBW) fetuses, we retrospectively studied perinatal factors and the outcome of two hundred twenty-eight VLBW infants without major anomaly excluding cases of multiple pregnancy. The frequency of malpresentation were significantly high in the early neonatal death group (p < 0.05) and in the cerebral palsy/mental retardation (CP/MR) group (p < 0.01). A stepwise regression analysis for the CP/MR detected dependent variables as malpresentation, use of tocolytic agents (beta(2)-stimulant plus MgSO4) and pH < 7.20 in cord artery. Delivery method was not a dependent variable for the early neonatal death or the CP/MR. We analyzed a relation between fetal presentation-delivery method, and the prognosis. Among four groups (cephalic-vaginal, cephalic-cesarean, breech-vaginal, breech-cesarean), the cephalic-vaginal group had the lowest incidence of the poor prognosis (death and major handicap) where the breech-vaginal had the highest incidence. Breech groups (vaginal plus cesarean) had significantly high incidence of the poor prognosis when compared with that of cephalic groups (vaginal plus cesarean) (p < 0.05). Significant difference of the prognosis between the cephalic-vaginal group and the cephalic-cesarean group was not observed. These findings suggest that the delivery method is not a risk factor, but the malpresentation itself may be a risk factor for the poor prognosis of VLBW infants.