SAN DIEGO — Planned primary cesarean delivery was associated with increased morbidity, compared with vaginal delivery, among low-risk primiparous women at term, results from a large population-based study showed.
Clinicians have debated the role of planned primary cesarean delivery over the last decade in particular, yet “there is little evidence to help guide us in how to counsel patients on the risks and benefits” of the procedure, Dr. Lisa May Olson reported at the annual meeting of the Society for Maternal-Fetal Medicine.
Dr. Olson, a recent graduate of the MD/MPH program at Oregon Health and Science University, Portland, noted that the rate of planned primary cesarean delivery in the United States has been increasing in the last decade, with a high of 20% in 2006, up from 17% in 2002.
Using administrative discharge data for low-risk primiparous women who gave birth to a term singleton infant in California, Dr. Olson and her associates compared maternal and neonatal outcomes of planned primary cesarean, with and without labor, to maternal and neonatal outcomes of vaginal delivery.
The average age of the 122,578 women studied was 25 years. Of these, 111,486 (90.9%) had a vaginal delivery, 5,603 (4.6%) had a planned primary cesarean delivery with labor, and 5,489 (4.4%) had a planned primary cesarean delivery without labor.
Dr. Olson reported that the planned primary cesarean delivery with and without labor groups were associated with higher maternal morbidities, compared with the vaginal delivery group, including a 10- to 20-fold increased risk of cardiac complications, a 4- to 8-fold increased risk of major infection, and a 3-fold increased risk of anesthetic complications. On the other hand, planned primary cesarean delivery with and without labor had a protective effect on hemorrhage and the need for transfusion, reducing the risk of those outcomes by 1.5- to 3-fold.
Compared with neonates in the planned primary cesarean delivery without labor group, their counterparts delivered by planned primary cesarean in the presence of labor were 5 times more likely to have CNS complications, 2.3 times more likely to require NICU admission, 1.9 times more likely to have respiratory distress syndrome, and 1.6 times more likely to develop sepsis, Dr. Olson said.
The study was supported in part by a Tartar Fellowship and Greenlick Grant at the university.