Comparative neonatal morbidity of abdominal and vaginal deliveries after uncomplicated pregnancies
D. J. Annibale, T. C. Hulsey, C. L. Wagner and W. M. Southgate
Department of Pediatrics, Medical University of South Carolina, Charleston, USA.
OBJECTIVE: To determine whether the risk of cesarean section following
uncomplicated pregnancies has been reduced by current obstetric practices
by comparing the neonatal risk of vaginal deliveries with the risk incurred
following abdominal delivery in otherwise uncomplicated pregnancies.
DESIGN: Observational, cohort study. A subpopulation of 11,702 women
without complications of pregnancy was identified from a perinatal
database, classified by subsequent mode of delivery, and compared for
neonatal morbidity. This analysis was repeated after the cesarean section
group was further narrowed to include only "repeated elective" deliveries.
SETTING: Low-risk inborn setting. Tertiary care (level III nursery)
referral center and a community (level II nursery) hospital. INTERVENTION:
Cesarean section performed electively, for cephalopelvic disproportion, or
for failure to progress. OUTCOME VARIABLES: Chosen prior to data analysis:
neonatal mortality and morbidity. RESULTS: Groups differed with regard to
ethnicity and sex. Infants who were delivered by cesarean section were more
likely to have 1-minute Apgar scores less than 4, require intermediate or
intensive nursery care at admission (6.3% vs 1.3% [P < .001]), and
require greater respiratory support (mechanical ventilation, 1.6% vs 0.3%;
oxygen therapy, 4.9% vs 1.4%; or room air, 93.5% vs 98.4% [P < .001])
than infants who were delivered vaginally. Similar results were found when
patients who were delivered vaginally and by repeated elective cesarean
section were compared. CONCLUSION: Although reports have recently emerged
suggesting otherwise, abdominal delivery following an uncomplicated
pregnancy remains a risk factor for adverse neonatal outcome despite
current obstetric practices.
