COMPARATIVE NEONATAL MORBIDITY OF ABDOMINAL AND VAGINAL DELIVERIES AFTER UNCOMPLICATED PREGNANCIES

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.