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We investigated the perinatal and infant mortality and morbidity after iatrogenic or spontaneous onset of extremely preterm birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>The present study used data from the population\u2010based <jats:styled-content style=\"fixed-case\">EXPRESS<\/jats:styled-content> study comprising all infants delivered before 27<jats:sup>+0<\/jats:sup> gestational weeks in Sweden between 2004 and 2007. All fetuses alive at admission and with known mode of onset of delivery were included (682 live\u2010born infants; 65 intrapartum deaths). Four multivariate regression models were applied with adjustments for gestational age, fetal gender, multiple pregnancy, and birthweight.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After adjustment for gestational age, no significant differences were found between iatrogenic and spontaneous onsets of birth regarding intrapartum death, early neonatal death (0\u20106\u00a0d), or death within 364\u00a0days. In the group with iatrogenic onset of delivery, there was an increased risk for severe morbidity (odds ratio [<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>] 1.86, 95% confidence interval [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>] 1.15\u20103.02), severe bronchopulmonary dysplasia (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.90, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.10\u20103.26), and retinopathy of prematurity (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.99, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.21\u20103.27) after adjustment for gestational age, fetal gender, and multiple pregnancy. After additional adjustment for weight z\u2010scores at 36 gestational weeks, the associations were not significant. Within the group with spontaneous onset of delivery, fetuses with preterm prelabor rupture of membranes had increased mortality risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>No evidence was found for mode of onset of delivery (iatrogenic vs spontaneous) having an impact on neonatal or infant mortality or morbidity in extremely preterm infants. Instead, gestational age and growth deviation at birth seem to be associated with the outcome.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.13387","type":"journal-article","created":{"date-parts":[[2018,5,25]],"date-time":"2018-05-25T06:55:28Z","timestamp":1527231328000},"page":"1388-1395","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Outcome of extremely preterm infants after iatrogenic or spontaneous birth"],"prefix":"10.1111","volume":"97","author":[{"given":"Tomas","family":"Fritz","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Sahlgrenska University Hospital  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"K\u00e4ll\u00e9n","sequence":"additional","affiliation":[{"name":"Center for Reproductive Epidemiology Lund University  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karel","family":"Mar\u0161\u00e1l","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Lund University  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Jacobsson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Institute of Clinical Sciences Sahlgrenska Academy  Gothenburg Sweden"},{"name":"Area of Health Data and Digitalization Department of Genetics and Bioinformatics Norwegian Institute of Public Health  Oslo 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