• U Högberg, S Håkansson, F Serenius, and P A Holmgren.
• Obstetrics and Gynecology, Umeå University, Umeå, Sweden. ulf.hogberg@obgyn.umu.se
• Acta Obstet Gynecol Scand. 2006 Jan 1;85(12):1442-7.

ObjectivesTo describe indications for cesarean section for extremely preterm delivery, peri- and postoperative complications and perinatal outcome.DesignA case-referent study with clinical follow-up.SettingA tertiary perinatal center.PopulationAll deliveries at gestational age <28 weeks at Umeå University Hospital in 1997-2003. For preterm cesarean section referents were women with elective first-time term cesarean section.MethodsIndications for cesarean section delivery were assessed. Peri- and postoperative complications, asphyxia, and infant survival at discharge were described.ResultsThe cesarean section rate was 75%, in one third the operation was considered as difficult. Indications for extremely preterm abdominal delivery were severe disease during pregnancy and delivery complications. Six out of ten cesarean sections were performed on fetal indication. Nonisthmic incision was performed in 20% of cases. No major postoperative complications and few minor postoperative complications were noted. Irrespective of mode of delivery, few of the infants had severe asphyxia.ConclusionIn balancing the risks of complications related to the surgical procedure against the purported benefits of the infant, this study adds support to the argument to deliver even extremely preterm infants by cesarean section.

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