Term neonatal asphyxial seizures and peripartum deaths: lack of correlation with a rising cesarean delivery rate.
OBJECTIVE
The purpose of this analysis was to study the relationship between an increasing cesarean delivery rate and term neonatal seizures and peripartum deaths.


METHODS
This was a retrospective analysis of annually collated institutional data on cesarean delivery and perinatal outcome.


RESULTS
Of 77,350 women who delivered at 37 weeks' gestation or more through 12 years (1989 to 2000), the cesarean rate increased from 6.9% to 15.1%; perinatal mortality at term, average 3.1/1000, was unchanged. The cesarean rate for nulliparas doubled from 8.3% to 17.5%. The overall neonatal term seizure rate (overall 1.3/1000; and for nulliparas 2.5/1000) did not change. The overall peripartum death rate (0.8/1000) was unchanged, although the rate for nulliparas (1.5/1000) showed a significant decline. Overall seizure rate in nulliparas was 5-fold higher than in multiparas; presumed intrapartum asphyxia was associated with 84% of both seizures and neonatal deaths in nulliparas. Among 2547 prelabor cesarean deliveries, there were no peripartum deaths and one neonatal seizure, an incidence comparable with that in multiparas who labored.


CONCLUSIONS
Despite a greater than 2-fold rise in cesarean section rate, the seizure rate and overall peripartum death rate at term did not alter significantly. Neonatal seizures occurred 5 times more often following first deliveries.
Foley
Michael E
ME
Department of Obstetrics, National Maternity Hospital, Dublin, Ireland. mfoley@nmh.ie
Alarab
May
M
Daly
Leslie
L
Keane
Declan
D
Macquillan
Kathryn
K
O'Herlihy
Colm
C
D001238:Asphyxia Neonatorum / Q000453:epidemiology* / Q000209:etiology; D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007494:Ireland / Q000453:epidemiology; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012640:Seizures / Q000453:epidemiology / Q000209:etiology