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    Elective repeat cesarean delivery has worse outcomes than vaginal birth after cesarean

    Neonates born after elective repeat cesarean delivery are about twice as likely to be admitted to the neonatal intensive care unit (NICU) (9.3% vs. 4.9%; P=.025) and about twice as likely to require oxygen supplementation for delivery room resuscitation (41.5% vs. 23.2%; P<.01) and after NICU admission (5.8% vs. 2.4%; P<.028), when compared to those born vaginally after a previous cesarean (VBAC), according to the results of a retrospective cohort study involving 672 women with one prior CD.

    While neonates born by VBAC required the least delivery room resuscitation with oxygen, those born after failed VBAC required the most, underscoring the necessity of being able to successfully choose those women most likely to succeed at VBAC. The study reported that the factors that increased the likelihood of a failed VBAC include chorioamnionitis and induction of labor.

    Not surprisingly, failed VBACs also accounted for the most expensive total birth experience, including delivery and NICU use, followed by elective repeat CD with labor, and elective repeat CD without labor. Successful VBACs were the least expensive.

    The researchers conclude that given the risks and statistics surrounding subsequent deliveries, obstetricians require the utmost selectivity in choosing women for a primary CD.

    Kamath BD, Todd JK, Glazner JE, et al. Neonatal outcomes after elective cesarean delivery. Obstet Gynecol. 2009;113:1231-1238.


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