Scheduled Cesarean Delivery: Maternal and Neonatal Risks in Primiparous Women in a Community Hospital Setting

ABSTRACT

We compared the short-term maternal and neonatal outcomes of women who deliver by cesarean without labor compared with women who deliver by cesarean after labor or by vaginal birth. This was a retrospective cohort study of women delivering a first baby from 1998 to 2002. Hospital discharge diagnostic coding identified unlabored cesarean deliveries (UCDs), labored cesarean deliveries (LCDs), and vaginal births (VBs). Medical records were abstracted and mode of delivery confirmed. The three outcomes of interest were maternal bleeding complications, maternal febrile morbidity, and neonatal respiratory complications. Using logistic regression for each outcome, we investigated whether mode of delivery was associated with the outcome, independent of other factors. The study groups included 513 UCDs, 261 LCDs, and 251 VBs. Compared with the UCD group, the adjusted odds of bleeding complications was higher in the LCD comparison group (odds ratio [OR] 2.3; 95% confidence interval [CI] 1.21, 4.53) and the VB comparison group (OR 1.96; 95% CI 0.95, 4.02). The incidence of febrile morbidity was similar for both cesarean groups but lower in the VB group. Both comparison groups had lower odds of neonatal complications than the UCD group (OR for LCD comparison group 0.52; 95% CI 0.27, 0.95 and OR for VB comparison group 0.26; 95% CI 0.098, 0.59). Scheduled cesarean is associated with increased odds of neonatal respiratory complications but decreased odds of maternal bleeding complications.

KEYWORDS

Cesarean morbidity - elective cesarean - neonatal complications - maternal complications

REFERENCES

• 1 Hamilton B E, Martin J A, Ventura S J. Births: preliminary data for 2006.  Natl Vital Stat Rep. 2007;  56 1-18
• 2 Garcia F A, Miller H B, Huggins G R et al.. Effect of academic affiliation and obstetric volume on clinical outcome and cost of childbirth.  Obstet Gynecol. 2001;  97 567-576
• 3 Gregory K D, Korst L M, Platt L D. Variation in elective primary cesarean delivery by patient and hospital factors.  Am J Obstet Gynecol. 2001;  184 1521-1532 discussion 1532-4
• 4 Chauhan S P, Justice L, Sanderson M et al.. Primary cesarean delivery among uncomplicated term nulliparous parturients: the influence of group practice within a community hospital.  Am J Perinatol. 2008;  25 119-123
• 5 Visco A G, Viswanathan M, Lohr K N et al.. Cesarean delivery on maternal request.  Obstet Gynecol. 2006;  108 1517-1529
• 6 Minkoff H, Powderly K R, Chervenak F et al.. Ethical dimensions of elective primary cesarean delivery.  Obstet Gynecol. 2004;  103 387-392
• 7 Ghetti C, Chan B K, Guise J M. Physicians' responses to patient-requested cesarean delivery.  Birth. 2004;  31 280-284
• 8 Koroukian S M. Relative risk of postpartum complications in the Ohio Medicaid population: vaginal versus cesarean delivery.  Med Care Res Rev. 2004;  61 203-224
• 9 Allen V M, O'Connell C M, Liston R M et al.. Maternal morbidity associated with cesarean delivery without labor compared with spontaneous onset of labor at term.  Obstet Gynecol. 2003;  102 477-482
• 10 Hannah M E, Hannah W J, Hewson S A et al.. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. term breech trial collaborative group.  Lancet. 2000;  356 1375-1383
• 11 Declercq E, Menacker F, MacDorman M. Rise in “no indicated risk” primary caesareans in the united states, 1991–2001: cross sectional analysis.  BMJ. 2005;  330 71-72
• 12 Gregory K D, Korst L M, Gornbein J A et al.. Using administrative data to identify indications for elective primary cesarean delivery.  Health Serv Res. 2002;  37 1387-1401
• 13 Declercq E, Barger M, Cabral H J et al.. Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births.  Obstet Gynecol. 2007;  109 669-677
• 14 Korst L M, Gregory K D, Gornbein J A. Elective primary caesarean delivery: accuracy of administrative data.  Paediatr Perinat Epidemiol. 2004;  18 112-119
• 15 Liu S, Liston R M, Joseph K S et al.. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term.  CMAJ. 2007;  176 455-460
• 16 MacDorman M F, Declercq E, Menacker F et al.. Neonatal mortality for primary cesarean and vaginal births to low-risk women: application of an “intention-to-treat” model.  Birth. 2008;  35 3-8
• 17 Hansen A K, Wisborg K, Uldbjerg N et al.. Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study.  BMJ. 2008;  336 85-87
• 18 Richardson B S, Czikk M J, daSilva O et al.. The impact of labor at term on measures of neonatal outcome.  Am J Obstet Gynecol. 2005;  192 219-226
• 19 Gerten K A, Coonrod D V, Bay R C et al.. Cesarean delivery and respiratory distress syndrome: does labor make a difference?.  Am J Obstet Gynecol. 2005;  193 1061-1064
• 20 Hook B, Kiwi R, Amini S B et al.. Neonatal morbidity after elective repeat cesarean section and trial of labor.  Pediatrics. 1997;  100 348-353
• 21 van den Berg A, van Elburg R M, van Geijn H P et al.. Neonatal respiratory morbidity following elective caesarean section in term infants. A 5-year retrospective study and a review of the literature.  Eur J Obstet Gynecol Reprod Biol. 2001;  98 9-13
• 22 Burrows L J, Meyn L A, Weber A M. Maternal morbidity associated with vaginal versus cesarean delivery.  Obstet Gynecol. 2004;  103 907-912
• 23 Minkoff H, Chervenak F A. Elective primary cesarean delivery.  N Engl J Med. 2003;  348 946-950
• 24 Simoes E, Kunz S, Bosing-Schwenkglenks M et al.. Association between method of delivery and puerperal infectious complications in the perinatal database of Baden-Wurttemberg 1998–2001.  Gynecol Obstet Invest. 2005;  60 213-217