A study was conducted to determine the effect of obstetric management on the incidence of intraventricular hemorrhage in the very-low-birth-weight infant. The study covered four years and involved 488 live-born viable infants weighing between 500 and 1500 g, electronically monitored during labor and with echoencephalograms performed within the first three days of life. The overall incidence of intraventricular hemorrhage and mortality was 43 and 21%, respectively. However, both intraventricular hemorrhage and mortality, 72 and 44%, respectively, were increased for gestations less than 1000 g when compared with those between 1000 and 1500 g, 28 and 8%, respectively. Furthermore, the proportion of severe intraventricular hemorrhage (grade III or IV) was increased for gestations less than 1000 g, 32 versus 9%. The incidence of intraventricular hemorrhage and mortality, 57 and 26%, respectively, in the breech presenting infant over 1000 g delivered vaginally, was decreased by cesarean section, 27 and 9%, respectively, P < .05. The incidence and the severity of intraventricular hemorrhage were not affected by the status of membranes or length of labor. Neonatal asphyxia as defined by a cord pH of less than 7.20 and severe respiratory distress syndrome as defined by duration of intermittent positive pressure ventilation over 72 hours resulted in a statistically significant increase of severe cases of intraventricular hemorrhage.