Subscribe to RSS
DOI: 10.1055/s-0029-1214240
The Risk of Acute Neonatal Morbidities in the Delivery Room after Primary Cesarean at Term: Influence of Labor and Stage
Publication History
Publication Date:
18 May 2009 (online)
![](https://www.thieme-connect.de/media/ajp/200908/lookinside/thumbnails/10.1055-s-0029-1214240-1.jpg)
ABSTRACT
We evaluated acute neonatal morbidities in the delivery room associated with primary cesarean performed prior to labor and in the first or second stages of labor. A retrospective cohort study was conducted on subjects undergoing term, primary cesareans at the Women's Pavilion, Miller Children's Hospital in Long Beach, California from 2000 to 2007. Acute neonatal morbidities were tabulated as a function of time during labor when cesarean was performed. Composite neonatal morbidity was defined as the presence of at least one of the following: low 5-minute Apgar score, need for intubation, and/or admission to neonatal intensive care unit. One thousand forty-five subjects delivered by cesarean without labor, 3098 in first stage, and 951 in second stage. Five-minute Apgar score < 7 was more common in cesareans performed during second stage than during first stage or without labor [3/1045 (0.3%) versus 28/3098 (0.9%) versus 12/951 (1.3%), p = 0.039]. Composite neonatal morbidity was not significantly different among the stages. Acute neonatal morbidities were not affected by the presence or absence of labor. Potential long-term sequelae require further study.
KEYWORDS
Cesarean delivery - labor - neonatal morbidity
REFERENCES
- 1 Martin J A, Hamilton B E, Sutton P D et al.. Births: final data for 2005. Natl Vital Stat Rep. 2007; 56 1-103
- 2 Gharaibeh A M, Al-Bdour A E, Akasheh H F. The mounting rate of cesarean sections: is it accompanied by a drop in instrumental births?. Saudi Med J. 2008; 29 267-270
- 3 Lavin Jr J P, Eaton J, Hopkins M. Teaching vaginal breech delivery and external cephalic version. A survey of faculty attitudes. J Reprod Med. 2000; 45 808-812
- 4 Hannah M E, Hannah W J, Hewson S A, Hodnett E D, Saigal S, Willan A R. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomized multicenter trial. Term Breech Trial Collaborative Group. Lancet. 2000; 356 1375-1383
- 5 Vimercati A, Greco P, Kardashi A et al.. Choice of cesarean and perception of legal pressure. J Perinat Med. 2000; 28 111-117
- 6 Lydon-Rochelle M, Holt V L, Easterling T R, Martin D P. Risk of uterine rupture during labor among women with a prior cesarean delivery. N Engl J Med. 2001; 345 3-8
- 7 Greene M F. Vaginal birth after cesarean revisited. N Engl J Med. 2004; 351 2647-2649
- 8 Bettes B A, Coleman V H, Zinberg S et al.. Cesarean delivery on maternal request: obstetrician-gynecologists' knowledge, perception, and practice patterns. Obstet Gynecol. 2007; 109 57-66
- 9 American College of Obstetrics and Gynecology . Cesarean delivery on maternal request. Obstet Gynecol. 2007; 110 1209-1212
- 10 Declercq E, Menacker F, MacDorman M. Rise in “no indicated risk” primary cesareans in the United States 1991–2001: cross sectional analysis. BMJ. 2005; 330 71-72
- 11 National Institutes of Health . State-of-the–science-conference statement. Cesarean delivery on maternal request. Obstet Gynecol. 2006; 107 1386-1397
- 12 Lydon-Rochelle M, Holt V L, Easterling T R, Martin D P. First birth cesarean and placental abruption or previa at second birth. Obstet Gynecol. 2001; 97 765-769
- 13 Minkoff H, Powderly K R, Chervenak F, McCullough L B. Ethical dimensions of elective primary cesarean delivery. Obstet Gynecol. 2004; 103 387-392
- 14 Hale R W, Harer W B. Elective prophylactic cesarean delivery [editorial]. ACOG Clinical Review. 2005; 10 1,-15
- 15 Murphy D J. Failure to progress in the second stage of labor. Curr Opin Obstet Gynecol. 2001; 13 557-561
- 16 Murphy D J, Liebling R, Verity L, Swingler R, Patel R. Early maternal and neonatal morbidity associated with operative delivery in second stage of labour: a cohort study. Lancet. 2001; 358 1203-1207
- 17 Murphy D J, Liebling R, Patel R, Verity L, Swingler R. Cohort study of operative delivery in the second stage of labour and standard of obstetric care. BJOG. 2003; 110 610-615
- 18 Alexander J M, Leveno K J, Rouse D J et al.. Comparison of maternal and infant outcomes from primary cesarean delivery during the second compared with first stage of labor. Obstet Gynecol. 2007; 109 917-921
- 19 MacLennan A. A template for defining a causal relation between acute intrapartum events and cerebral palsy: international consensus statement. BMJ. 1999; 319 1054-1059
- 20 Nathan L, Leveno K J, Carmody III T J, Kelly A M, Sherman M L. Meconium: a 1990's perspective on an old obstetric hazard. Obstet Gynecol. 1994; 83 329-332
- 21 Katz V L, Bowes Jr W A. Meconium aspiration syndrome: reflections on a murky subject. Am J Obstet Gynecol. 1992; 166 171-183
- 22 Wiswell T E, Bent R C. Meconium staining and then meconium aspiration syndrome. Pediatr Clin North Am. 1993; 40 955-981
- 23 Greenwood C, Lalchandani S, MacQuillan K, Sheil O. Meconium passed in labor: how reassuring is clear amniotic fluid?. Obstet Gynecol. 2003; 102 89-93
- 24 American College of Obstetrics and Gynecologists .Induction of labor. ACOG Practice Bulletin, No. 10. Washington, DC; ACOG November 1999
- 25 American College of Obstetrics and Gynecologists .Dystocia and augmentation of labor. ACOG Practice Bulletin, No. 49. Washington, DC; ACOG December 2003
- 26 Myles T D, Santolaya J. Maternal and neonatal outcomes in patients with a prolonged second stage of labor. Obstet Gynecol. 2003; 102 52-58
- 27 Cheng Y W, Hopkins L M, Caughey A B. How long is too long: does a prolonged second stage in nulliparous women affect maternal and neonatal outcomes?. Am J Obstet Gynecol. 2004; 191 933-938
- 28 Cheng Y W, Hopkins L M, Laros R K, Caughey A B. Duration of the second stage of labor in multiparous women: maternal and neonatal outcomes. Am J Obstet Gynecol. 2007; 196 585
- 29 Heritage C K, Cunningham M D. Association of elective repeat cesarean delivery and persistent pulmonary hypertension of the newborn. Am J Obstet Gynecol. 1985; 152 627-629
- 30 Levine Em, Ghai V, Barton J J, Strom C M. Mode of delivery and risk of respiratory diseases in newborns. Obstet Gynecol. 2001; 97 439-442
Kim WinovitchM.D.
101 The City Drive South, Building 56
Suite 800, Orange, CA 92868
Email: mfm@uci.edu