Planned cesarean versus planned vaginal delivery at term: Comparison of newborn infant outcomes

Kolås, Toril; Saugstad, Ola Didrik; Daltveit, Anne Kjersti; Nilsen, Stein Tore; Øian, Pål

doi:10.1016/j.ajog.2006.05.005

Cited by 144 publications

(104 citation statements)

References 24 publications

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“…Much of the data on neonatal morbidity includes infants less than 37 weeks, which is a known risk factor for respiratory morbidity. 7 Kolas et al 13 found no difference in neonatal respiratory outcomes when the analysis was limited to a gestational age of greater than or equal to 39 weeks. When Zanardo et al 7 stratified by gestational age, they found no difference in the rate of respiratory distress syndrome at or beyond 39 weeks gestation between vaginal delivery and unlabored cesarean delivery.…”

Section: Discussionmentioning

confidence: 99%

“…Kolas et al 13 had a rate of 5.8% when examining planned cesarean versus planned vaginal delivery at term. The fact that planned vaginal delivery had a lower rate of NICU admission is interesting, given that there was no difference in the rate of sepsis; and the rates of chorioamnionitis (9.6 vs 0.6%, P<0.001) and low 1 min Apgar (9.0 vs 4.0%, P ¼ 0.02) were both increased in the Planned vaginal vs planned primary cesarean delivery EJ Geller et al planned vaginal delivery group.…”

Section: Discussionmentioning

confidence: 99%

“…17,18 In many cases, information on parity and maternal morbidities was not available, making it difficult to determine what effects were due to parity or comorbidity and what were actually due to planned route of delivery. 13 Another strength of this study is the use of large, universitybased databases that include detailed data on demographic, labor and delivery and postnatal information over a 10-year time span that is populated and maintained by clinical research nurses. Although some may argue that the 10-year time span may be affected by changes in practice patterns over time, we are assessing intent to deliver by cesarean and what effects that has on neonatal outcomes, not what practice pattern led to making that decision.…”

Section: Discussionmentioning

confidence: 99%

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Neonatal outcomes associated with planned vaginal versus planned primary cesarean delivery

Geller

Jannelli

et al. 2009

J Perinatol

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Objective: To determine whether planned route of delivery leads to differences in neonatal morbidity.Study Design: Analysis was based on planned route of delivery, not actual route of delivery. A total of 4048 subjects were divided into two groups: planned vaginal delivery and planned cesarean delivery. Primary outcomes were neonatal intensive care unit (NICU) admission, respiratory morbidity and neurologic morbidity.Result: There were 3868 planned vaginal and 180 planned cesarean deliveries. Planned vaginal delivery had decreased NICU admission (P<0.0001), oxygen resuscitation (P ¼ 0.001) and jaundice (P<0.0001) but increased meconium passage (P<0.0001) and 1 min Apgar p5 (P ¼ 0.02). After multivariable regression, NICU admission remained lower and meconium passage remained higher in the planned vaginal group.Conclusion: Planned vaginal delivery led to more meconium passage and low 1 min Apgar but less NICU admissions, oxygen resuscitation and jaundice. Multicenter trials are needed to assess rare but serious outcomes based on planned route of delivery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Neonatal outcomes associated with planned vaginal versus planned primary cesarean delivery

Geller

Jannelli

et al. 2009

J Perinatol

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“…16 These risks can be attributed not only to the emergency status of the operation and the jeopardy brought about by the surgical technique, but also to the potential hazards produced by the anesthetic method. Today, there is still no unquestionably recognized and ideal cesarean technique nor is there a single anesthetic method, although the global trend is shifting towards regional anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial

Saygı¹,

Özdamar²,

Gün

et al. 2015

Sao Paulo Med. J.

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CONTEXT AND OBJECTIVE: As the rates of cesarean births have increased, the type of cesarean anesthesia has gained importance. Here, we aimed to compare the effects of general and spinal anesthesia on maternal and fetal outcomes in term singleton cases undergoing elective cesarean section. DESIGN AND SETTING: Prospective randomized controlled clinical trial in a tertiary-level public hospital. METHODS: Our study was conducted on 100 patients who underwent cesarean section due to elective indications. The patients were randomly divided into general anesthesia (n = 50) and spinal anesthesia (n = 50) groups. The maternal pre and postoperative hematological results, intra and postoperative hemodynamic parameters and perinatal results were compared between the groups. RESULTS: Mean bowel sounds (P = 0.036) and gas discharge time (P = 0.049) were significantly greater and 24 th hour hemoglobin difference values (P = 0.001) were higher in the general anesthesia group. The mean hematocrit and hemoglobin values at the 24 th hour (P = 0.004 and P < 0.001, respectively), urine volume at the first postoperative hour (P < 0.001) and median Apgar score at the first minute (P < 0.0005) were significantly higher, and the time that elapsed until the first requirement for analgesia was significantly longer (P = 0.042), in the spinal anesthesia group. CONCLUSION: In elective cases, spinal anesthesia is superior to general anesthesia in terms of postoperative comfort. In pregnancies with a risk of fetal distress, it would be appropriate to prefer spinal anesthesia by taking the first minute Apgar score into account. CLINICAL TRIAL REGISTRY: NTR17990 RESUMOCONTEXTO E OBJETIVO: Como as taxas de partos cesáreos aumentaram, o tipo de anestesia na cesariana ganhou importância. Comparamos os efeitos da anestesia geral e da raquianestesia sobre os resultados maternos e fetais em casos de gestação única e no termo, com cesariana eletiva. TIPO DE ESTUDO E LOCAL: Ensaio clínico prospectivo, randomizado e controlado, em hospital público terciário. MÉTODOS: Estudo realizado com 100 pacientes que se submeteram a cesariana por indicação eletiva. As pacientes foram divididos aleatoriamente em grupos recebendo anestesia geral (n = 50) e raquianestesia (n = 50). Resultados maternos hematológicos pré e pós-operatórios, variáveis hemodinâmicas intra e pós-operatórias e resultados perinatais foram comparados entre os grupos. RESULTADOS: As médias de ruídos intestinais (P = 0,036) e tempo de descarga de gás (P = 0,049) foram significativamente mais elevadas e os valores de diferença de hemoglobina na 24 a hora (P = 0,001) foram maiores no grupo anestesia geral. Os valores médios de hematócrito e hemoglobina na 24 a hora (P = 0,004 e P < 0,001, respectivamente), o volume de urina na primeira hora de pós-operatório (P < 0,001) e a pontuação mediana de Apgar no primeiro minuto (P < 0,0005) foram significativamente maiores, e o tempo até o primeiro requerimento de analgésicos também foi significativamente maior (P = 0,042) no grupo raquianestesia. C...

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“…7,10,32,40,42,47,50,53,58,59,62,75,77,85,86,89,94,96,97,109,116,117,125,127,135,137 In contrast, however, the incidence of birth asphyxia, trauma, and meconium aspiration is lower, and these advantages of elective cesarean delivery have been reviewed elsewhere in this issue of Clinics.…”

Section: Respiratory Morbidity In Infants Delivered By Cesarean Deliverymentioning

confidence: 99%

Elective Cesarean Section: Its Impact on Neonatal Respiratory Outcome

Ramachandrappa¹,

Jain²

2008

Clinics in Perinatology

158

108

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The transition from a fluid filled lung to one filled with air in a very short period of time is one of the biggest challenges a newborn faces after birth. Respiratory morbidity as a result of failure to clear fetal lung fluid is not uncommon, and can be particularly problematic in some infants delivered by elective cesarean section (ECS) without being exposed to labor. The increasing rates of cesarean deliveries in the United States and worldwide, have the potential for a significant impact on public health and health care costs due to the morbidity associated with this subgroup. Whereas the occurrence of birth asphyxia, trauma, and meconium aspiration is reduced by elective cesarean delivery, the risk of respiratory distress secondary to transient tachypnea of the newborn, surfactant deficiency, and pulmonary hypertension is increased. It is clear that physiologic events in the last few weeks of pregnancy coupled with the onset of spontaneous labor are accompanied by changes in the hormonal milieu of the fetus and its mother, resulting in preparation of the fetus for neonatal transition. Rapid clearance of fetal lung fluid is a key part of these changes, and is mediated in large part by transepithelial sodium reabsorption through amiloride-sensitive sodium channels in the alveolar epithelial cells, with only a limited contribution from mechanical factors and Starling forces. In this chapter we discuss the respiratory morbidity associated with ECS, the physiologic mechanisms underlying fetal lung fluid absorption and potential strategies for facilitating neonatal transition when infants are delivered by ECS before the onset of spontaneous labor. The changing landscape for human deliveriesCesarean births rose for an tenth straight year in 2006 to a record 31.1% of all deliveries in the United States; this rate is more than 50% higher than in 1996 and is accompanied by a significant drop in the number of women attempting vaginal birth after a previous cesarean delivery (VBAC). 56 ( Fig. 1) Most of the overall increase can be attributed to the increase in the primary cesarean rates, from 14.6% in 1996 to 20.3% in 2005. This rise in the primary cesarean rate coupled with the decrease in the VBAC rate (7.9% in 2005) means that women who have a primary cesarean section have a greater than 90% chance of having a repeat cesarean section, further increasing the overall cesarean rate in the future. 90 Among the many reasons cited for this increase are older women giving birth, multiple gestations from fertility treatments, as well as the concerns of physicians and mothers about the risks of vaginal birth. Cesarean births in low risk or "no risk" mothers where no medical indication can be identified are on the rise and are often referred to as Cesarean Delivery at Maternal Request (CDMR).Address for Correspondence and Reprints: Lucky Jain, MD, MBA, Professor of Pediatrics & Executive Vice Chairman, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta GA 30322, ljain@emory.edu, 404-727-1471. Coauthor...

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Planned cesarean versus planned vaginal delivery at term: Comparison of newborn infant outcomes

Cited by 144 publications

References 24 publications

Neonatal outcomes associated with planned vaginal versus planned primary cesarean delivery

Neonatal outcomes associated with planned vaginal versus planned primary cesarean delivery

Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial

Elective Cesarean Section: Its Impact on Neonatal Respiratory Outcome

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