title: Scheduled cesarean delivery: maternal and neonatal risks in primiparous women in a community hospital setting.
abstract: We compared the short-term maternal and neonatal outcomes of women who deliver by cesarean without labor compared with women who deliver by cesarean after labor or by vaginal birth. This was a retrospective cohort study of women delivering a first baby from 1998 to 2002. Hospital discharge diagnostic coding identified unlabored cesarean deliveries (UCDs), labored cesarean deliveries (LCDs), and vaginal births (VBs). Medical records were abstracted and mode of delivery confirmed. The three outcomes of interest were maternal bleeding complications, maternal febrile morbidity, and neonatal respiratory complications. Using logistic regression for each outcome, we investigated whether mode of delivery was associated with the outcome, independent of other factors. The study groups included 513 UCDs, 261 LCDs, and 251 VBs. Compared with the UCD group, the adjusted odds of bleeding complications was higher in the LCD comparison group (odds ratio [OR] 2.3; 95% confidence interval [CI] 1.21, 4.53) and the VB comparison group (OR 1.96; 95% CI 0.95, 4.02). The incidence of febrile morbidity was similar for both cesarean groups but lower in the VB group. Both comparison groups had lower odds of neonatal complications than the UCD group (OR for LCD comparison group 0.52; 95% CI 0.27, 0.95 and OR for VB comparison group 0.26; 95% CI 0.098, 0.59). Scheduled cesarean is associated with increased odds of neonatal respiratory complications but decreased odds of maternal bleeding complications.
authors.affiliation: Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA. lhq@aol.com
authors.forename: Lieschen H
authors.initials: LH
authors.lastname: Quiroz
authors.forename: Howard
authors.initials: H
authors.lastname: Chang
authors.forename: Joan L
authors.initials: JL
authors.lastname: Blomquist
authors.forename: Yvonne K
authors.initials: YK
authors.lastname: Okoh
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Handa
mesh_terms: D000328:Adult; D001720:Birth Injuries / Q000453:epidemiology; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D016001:Confidence Intervals; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods; D017558:Elective Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005865:Gestational Age; D006764:Hospitals, Community; D006801:Humans; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000453:epidemiology*; D016015:Logistic Models; D008428:Maternal Mortality / Q000639:trends; D008429:Maternal Welfare; D007744:Obstetric Labor Complications / Q000175:diagnosis / Q000453:epidemiology; D016017:Odds Ratio; D010298:Parity; D006473:Postpartum Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D011336:Probability; D012189:Retrospective Studies; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects*; D055815:Young Adult