Dj. Annibale et al., COMPARATIVE NEONATAL MORBIDITY OF ABDOMINAL AND VAGINAL DELIVERIES AFTER UNCOMPLICATED PREGNANCIES, Archives of pediatrics & adolescent medicine, 149(8), 1995, pp. 862-867
Objective: To determine whether the risk of cesarean section following
uncomplicated pregnancies has been reduced by current obstetric pract
ices by comparing the neonatal risk of vaginal deliveries with the ris
k incurred following abdominal delivery in otherwise uncomplicated pre
gnancies. Design: Observational, cohort study. A subpopulation of 11 7
02 women without complications of pregnancy was identified from a peri
natal database, classified by subsequent mode of delivery, and compare
d for neonatal morbidity. This analysis was repeated after the cesarea
n section group was further narrowed to include only ''repeated electi
ve'' deliveries. Setting: Low-risk inborn setting. Tertiary care (leve
l III nursery) referral center and a community (level II nursery) hosp
ital. Intervention: Cesarean section performed electively, for cephalo
pelvic disproportion, or for failure to progress. Outcome Variables: C
hosen prior to data analysis: neonatal mortality and morbidity. Result
s: 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 dare at
admission (6.3% vs 1.3% [P<.001]), and require greater respiratory sup
port (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 delive
red vaginally. Similar results were found when patients who were deliv
ered vaginally and by repeated elective cesarean section were compared
. Conclusion: Although reports have recently emerged suggesting otherw
ise, abdominal delivery following an uncomplicated pregnancy remains a
risk factor for adverse neonatal outcome despite current obstetric pr
actices.