Mode of delivery for periviable birth

The optimal mode of delivery when periviable birth is anticipated has been the subject of considerable discussion. Potentially, cesarean delivery could avert intrapartum fetal trauma and asphyxia and allow timed delivery to assure readiness of neonatal intensive care resources. However, cesarean delivery in the early preterm period commonly necessitates a classical vertical uterine incision involving the fundus with its associated acute and long-term risks to the mother and future pregnancies. In this study we evaluated the currently available literature regarding routine cesarean delivery, cesarean delivery for fetal malpresentation, and cesarean delivery for fetal indication near the limit of viability. Randomized controlled trials of adequate size regarding this issue are lacking. Data from retrospective and observational studies do not support routine cesarean delivery for all early preterm infants. Cesarean delivery may offer survival advantage to the periviable growth-restricted infant regardless of fetal presentation and appears to offer survival benefit to the malpresenting fetus.