May 2008: Neonatal outcomes with caesarean delivery at term

[Stefan Johansson]

Leading articles - May 2008

The Leading articles for May 2008, one Perspective article and one Original article, are about neonatal outcomes with caesarean delivery at term.

The articles are published in collaboration with the journal Archives of Disease in Childhood (http://adc.bmj.com/).

Permission to publish the abstract has been given by Archives of Disease in Childhood.

* * * * * * * * * * * * * * * * * * *
PERSPECTIVE
Neonatal outcomes with caesarean delivery at term (http://fn.bmj.com/cgi/content/full/93/3/F174)
Dharmintra Pasupathy, Gordon C S Smith

Department of Obstetrics and Gynaecology, Cambridge University, Cambridge, UK



ORIGINAL ARTICLE
Neonatal outcomes with caesarean delivery at term (http://fn.bmj.com/cgi/content/full/93/3/F176)
F A Liston, V M Allen, C M O’Connell, K A Jangaard

Department of Obstetrics and Gynaecology, Department of Paediatrics, Department of Perinatal Epidemiology, Research Unit, Dalhousie University, Halifax, Nova Scotia, Canada

ABSTRACT

Objective: To estimate the impact of caesarean delivery on the incidence of selected neonatal outcomes.

Methods: A 15-year, population-based, cohort study (1988–2002) using the Nova Scotia Atlee Perinatal Database compared neonatal outcomes in term newborns born by spontaneous and assisted vaginal delivery, with newborns born by caesarean delivery, with and without labour, using multiple logistic regression.

Results: From a total of 142 929 deliveries, there were 27 263 caesarean deliveries, 61% of which were performed in labour. Relative risks were adjusted for year of birth, maternal age, parity, smoking, maternal weight at delivery, hypertensive diseases, diabetes, previous caesarean delivery, use of regional anaesthesia, induction of labour, gestational age at delivery and large and small for gestational age, where significant. Caesarean delivery in labour, but not caesarean delivery without labour, had increased risks for depression at birth and neonatal respiratory conditions compared with spontaneous or assisted vaginal delivery. Compared with spontaneous vaginal delivery and assisted vaginal delivery, the risk of major neonatal birth trauma was decreased for infants after caesarean delivery with labour (odds ratio (OR) = 0.34, 95% CI 0.21 to 0.56 and OR = 0.07, 95% CI 0.04 to 0.11, respectively) and caesarean delivery without labour (OR = 0.20, 95% CI 0.08 to 0.52 and OR = 0.04, 95% CI 0.02 to 0.10, respectively).

Conclusion: Caesarean delivery in labour, compared with vaginal delivery, is more likely to be associated with an increased risk for respiratory conditions and depression at birth than caesarean delivery without labour. Caesarean delivery appears protective against neonatal birth trauma, especially when performed without labour.
* * * * * * * * * * * * * * * * * * *

You may comment the article directly below or discuss neoantal aspects of mode of delivery in appropriate forums.

[Stefan Johansson]

Dr Haque, who is also a 99nicu member, emailed me and informed me about his article about mode of delivery in preterm VLBW infants. See part of the abstract below.

Click here to read the complete abstract in PubMed. (http://www.ncbi.nlm.nih.gov/pubmed/17694314)

Caesarean or vaginal delivery for preterm very-low-birth weight (< or =1,250 g) infant: experience from a district general hospital in UK.
Haque KN, Hayes AM, Ahmed Z, Wilde R, Fong CY.

Neonatal Intensive Care Unit, St Helier University Hospital, Wrythe Lane, Carshalton, Surrey, UK

OBJECTIVE: To determine whether delivery by caesarean is associated with a better neuro-developmental outcome at two years for preterm infants born weighing 1,250 g or less.

SETTING & DESIGN: District General Hospital, United Kingdom. All inborn infants weighing <1,250 g born at St Helier University Hospital between January 1995 and December 2003 were identified from contemporaneously collected computer database.

RESULTS: The overall caesarean delivery rate for this cohort was 51.6% while the overall caesarean rate for all births at our hospital during the study period varied between 20 and 23%. Neonatal mortality for those delivered by caesarean was 12.7% compared to 14.5% for those delivered vaginally (p = ns). Overall incidence of any neuro-disability at two years of age was 46.8% for those delivered by caesarean compared to 47.7% for those delivered vaginally (p = ns). There was no difference in those with severe (23.5% vs. 25.0%), moderate (10.4% vs. 9%) or mild (12.5% vs. 13.6%) neuro-disability between the groups nor was there any difference in the number of babies with IVH, chronic lung disease and NEC. Neuro-disability was equally greater in both groups for babies born weighing 750 grams or less and/or born at 26 weeks or less gestation.

CONCLUSION: Despite the increasing tendency to deliver extremely preterm babies by caesarean, we did not find that it was associated with either reduced mortality or neuro-disability at two years of age. Therefore the method of delivery of very-low-birth weight premature infants should be based on obstetric or maternal indications rather than the perceived outcome of the baby.