**17. Mode of delivery**

Vaginal delivery is considered to be appropriate choice in gestations under 24 weeks as the neonatal survival rate is very low. The challanging decision is the balance of vaginal delivery versus caesarean section in preterm delivery between 24 weeks and 37 weeks gestation [1, 24].

The decision for caesarean section is recommended to be for the obstetric reasons such as malpresentations and intrapartum fetal distress. Cochrane review for elective caesarean section in women with threating preterm labour between 24 and 37 weeks gestation has not shown statistically significant difference in the neonatal outcomes with regard the incidence of respiratory distress syndrome and neonatal seizures.

There is no evidence to support routine prophylactic outlet forceps or episiotomy when considering vaginal delivery between 24 and 37 weeks gestations. It is advisable to leave the fetal membranes intact till late in labour to reduce the risk of cord prolapse. The fetal scalp electrode and fetal blood sampling use is contraindicated prior to 34 weeks gestation and hence any suspicious fetal monitoring trace should be considered as indication for caesarean section. Their use is considered between 34 and 36 weeks gestation. It is also important to note that ventouse delivery is contraindicated prior to 34 weeks gestation. Consideration should be taken for caesarean section in preterm delivery with breech presentation [1, 24].

Delayed cord clamping for at least 30 seconds but no longer than three minutes is advisable in preterm deliveries to allow auto transfusion of the baby. Senior obstetrician should be consulted in planning the delivery and the decision-making throughout the labour [1, 24].

Parents should have discussion with joint obstetric and neonatal team prior embarking onto labour is helpful to ensure their understanding of challenges for the preterm baby such as ability to maintain stable core body temperature, ability to breath spontaneously and feeding difficulties. The expected postnatal care for the preterm baby should be planned as detailed as possible with the parents and ensure the availability of the facilities.

*Preterm Labour DOI: http://dx.doi.org/10.5772/intechopen.96049*
