Elective Cesarean Section on Term Pregnancies Has a High Risk for Neonatal Respiratory Morbidity in Developed Countries: A Systematic Review and Meta-Analysis

Abstract

Background: Cesarean section (CS) is one of the most recurrently carried out surgical procedures in modern obstetrics. Worldwide, about 18.5 million CSs are conducted annually. Of this, 21-33% are performed in middle-and high-income countries. The effectiveness of the CS in preventing maternal and prenatal mortality and morbidity is medically justifiable. However, cesarean delivery without demanding obstetrical indications, by mere maternal request, may expose the child to several risks over benefits. Therefore, we aim to compare spontaneous vaginal delivery (vaginal delivery other than operative vaginal deliveries) and elective CS (CS before the onset of labor, but not including emergency CS) in decreasing the risk of neonatal respiratory morbidity. Objective: To compare the risk of neonatal respiratory morbidity in ECS and spontaneous vaginal delivery. Methods: A literature search was performed through visiting an electronic database (MEDLINE, PubMed, EMBASE, and CINAHL) and gray literature sources, including Google and Google Scholar, from January 2000 to May 2018. Original observational studies that reported the risk of neonatal respiratory morbidity in relation to mode of delivery conducted in the English language were identified and screened. Joanna Briggs Institute's quality assessment tool for observational studies was used to critically appraise the methodological quality of studies. Synthesis of individual studies was conducted using the Review Manager Software version 5.3 for Windows. Heterogeneity among studies was explored using the Cochran's Q-test and the I 2 statistics. Pooled effect sizes in relative risk ratios with 95% confidence intervals were calculated. The flow of the study was prepared according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) checklist. Tefera et al. ECS Is Risk for Neonatal Respiratory Morbidity Results: Sixteen studies were reviewed. A total of 327,272 neonates born by vaginal delivery and 55,246 born by ECS were included in this study. The risk of neonatal respiratory morbidity was increased by 95% in neonates delivered by ECS (RR = 1.95; 95% CI: 1.40-2.73) as compared with neonates born by spontaneous vaginal delivery. Conclusion: This study investigated the effect of mode of delivery on the respiratory morbidity without considering other risks and found that the ECS has a high risk of developing neonatal respiratory morbidities when compared to spontaneous vaginal delivery. So, we recommend discouraging unnecessary CS. registration: CRD42018104905.

Elective cesarean delivery at term and its effects on respiratory distress at birth in Japan: The Japan Environment and Children's Study

“…This study also showed that early‐term birth was associated with an increased risk of respiratory distress among neonates delivered via cesarean delivery at term with no indications for early delivery. This result is consistent with previous studies that showed the effects of early‐term birth on neonatal respiratory morbidity 34 , 35 and highlights the significance of the increasing frequency of early‐term births on neonatal health.…”

How to advise women with a medical history of surgically corrected anorectal malformation on vaginal delivery: a systematic review

“…For example, the incidence of postoperative ileus after cesarean section lies around the 12%. 23 In addition, there is a higher risk of postpartum sepsis, especially in an emergency cesarean section, and women who deliver by cesarean section are more likely to be admitted to the ICU. 23,24 Subsequent cesarean section carry even higher risks.…”

“…However, the risk of bleeding in a planned cesarean section is lower in comparison to a planned vaginal birth (respectively 1.1% and 6.0%). 23 Apart from adverse effects on the mother, a cesarean section can have disadvantages for the child as well.…”

Association of early neonatal-maternal outcomes with timing of elective caesarean section at term gestation

“…Recent systemic review and meta-analysis have concluded that newborn delivered by ECS is at a higher risk of developing respiratory complications in comparison to normal vaginal delivery (NVD). 1 Changes taking place in NVD contributing towards smooth neonatal respiratory transition include upsurge of catecholamine, corticosteroid release, mechanical chest compression by the birth canal and expression of sodium channel on foetal lung epithelium. 2,3 In ECS, lack of this catecholamine upsurge contributes to surfactant deficiency, making the neonatal transition more complex leading to increased incidence of NRM.…”