title: Neonatal morbidity after elective repeat cesarean section and trial of labor.
abstract: OBJECTIVE
  To evaluate neonatal outcomes after an elective repeat cesarean section (ERCS) compared with a trial of labor (TOL).
  
  
  METHODS
  All mothers who underwent previous cesarean section and delivered singleton infants at term gestation were identified during a 1-year period. Neonatal outcomes were compared between infants delivered by ERCS (n = 497) and those delivered by TOL (n = 492), and between infants delivered by a successful (n = 336) and a failed (n = 156) TOL. A cohort of mothers and their term infants delivered by routine vaginal delivery were also identified.
  
  
  RESULTS
  Infants delivered by ERCS had an increased rate of transient tachypnea compared with infants born by TOL (6% vs 3%). Compared with routine vaginal deliveries, the adjusted odds ratio of developing any respiratory problem after an ERCS was 2.3 (95% confidence interval [CI]: 1.4, 3.8), and for developing transient tachypnea was 2.6 (CI: 1.5, 4.5). In addition, two infants delivered by ERCS developed respiratory distress syndrome. Infants delivered after a TOL had increased rates of suspected and proven sepsis (5% vs 2% and 1% vs 0.1%, respectively). Compared with a successful TOL, the infants delivered by cesarean section after a failed TOL had more neonatal morbidity and had a longer hospital stay (4.8 +/- 2 vs 3.1 +/- 2 days). The odds ratio for developing any respiratory illness after a failed TOL was 2.1 (95% CI: 1.1, 4.1), for suspected sepsis was 4.8 (95% CI: 2.6, 9.0), and for proven sepsis was 19.3 (95% CI: 2.0, 187). Neonatal outcomes after a successful TOL were similar to routine vaginal births.
  
  
  CONCLUSIONS
  Infants born by ERCS are at increased risk for developing respiratory problems compared with those born by TOL. However, TOL is associated with increased rates of suspected and proven sepsis. This appears to be limited to infants delivered by cesarean section after a failed TOL.
authors.affiliation: Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
authors.forename: B
authors.initials: B
authors.lastname: Hook
authors.forename: R
authors.initials: R
authors.lastname: Kiwi
authors.forename: S B
authors.initials: SB
authors.lastname: Amini
authors.forename: A
authors.initials: A
authors.lastname: Fanaroff
authors.forename: M
authors.initials: M
authors.lastname: Hack
mesh_terms: D017604:Cesarean Section, Repeat / Q000009:adverse effects; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000009:adverse effects; D004417:Dyspnea / Q000209:etiology; D017558:Elective Surgical Procedures; D005260:Female; D005865:Gestational Age; D006760:Hospitalization; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome; D012120:Respiration Disorders / Q000209:etiology*; D012127:Respiratory Distress Syndrome, Newborn / Q000209:etiology; D018805:Sepsis / Q000209:etiology; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects