Neonatal outcomes after elective cesarean delivery.
OBJECTIVE
To examine the outcomes of neonates born by elective repeat cesarean delivery compared with vaginal birth after cesarean (VBAC) in women with one prior cesarean delivery and to evaluate the cost differences between elective repeat cesarean and VBAC.


METHODS
We conducted a retrospective cohort study of 672 women with one prior cesarean delivery and a singleton pregnancy at or after 37 weeks of gestation. Women were grouped according to their intention to have an elective repeat cesarean or a VBAC (successful or failed). The primary outcome was neonatal intensive care unit (NICU) admission and measures of respiratory morbidity.


RESULTS
Neonates born by cesarean delivery had higher NICU admission rates compared with the VBAC group (9.3% compared with 4.9%, P=.025) and higher rates of oxygen supplementation for delivery room resuscitation (41.5% compared with 23.2%, P<.01) and after NICU admission (5.8% compared with 2.4%, P<.028). Neonates born by VBAC required the least delivery room resuscitation with oxygen, whereas neonates delivered after failed VBAC required the greatest degree of delivery room resuscitation. The costs of elective repeat cesarean were significantly greater than VBAC. However, failed VBAC accounted for the most expensive total birth experience (delivery and NICU use).


CONCLUSIONS
In comparison with vaginal birth after cesarean, neonates born after elective repeat cesarean delivery have significantly higher rates of respiratory morbidity and NICU-admission and longer length of hospital stay.


METHODS
II.
Kamath
Beena D
BD
From the Departments of Pediatrics, Section of Neonatology, and Obstetrics and Gynecology, University of Colorado School of Medicine; Department of Infectious Disease and Epidemiology, the Children's Hospital, Denver; and Colorado School of Public Health, Denver, Colorado.
Todd
James K
JK
Glazner
Judith E
JE
Lezotte
Dennis
D
Lynch
Anne M
AM
D000328:Adult; D002585:Cesarean Section; D017604:Cesarean Section, Repeat; D015331:Cohort Studies; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007231:Infant, Newborn / Q000502:physiology*; D015931:Intensive Care, Neonatal; D007902:Length of Stay; D011247:Pregnancy; D011256:Pregnancy Outcome; D012151:Resuscitation; D012189:Retrospective Studies