PEDIATRICS Vol. 100 No. 3 September 1997, pp. 348-353

Neonatal Morbidity After Elective Repeat Cesarean Section and Trial of Labor

Received Aug 21, 1996; accepted Jan 13, 1997.

Brenda Hook^*, Robert Kiwi, Saeid B. Amini^§, Avroy Fanaroff^*, and Maureen Hack^*

From the Departments of ^* Pediatrics,  Reproductive Biology, and ^§ Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, Ohio.

Objective.  To evaluate neonatal outcomes after an elective repeat cesarean section (ERCS) compared with a trial of labor (TOL).

Population and Method.  All mothers who underwent previous cesarean section and delivered singleton infants at term gestation were identified during a 1-year period. Neonatal outcomes were compared between infants delivered by ERCS (n = 497) and those delivered by TOL (n = 492), and between infants delivered by a successful (n = 336) and a failed (n = 156) TOL. A cohort of mothers and their term infants delivered by routine vaginal delivery were also identified.

Results.  Infants delivered by ERCS had an increased rate of transient tachypnea compared with infants born by TOL (6% vs 3%). Compared with routine vaginal deliveries, the adjusted odds ratio of developing any respiratory problem after an ERCS was 2.3 (95% confidence interval [CI]: 1.4, 3.8), and for developing transient tachypnea was 2.6 (CI: 1.5, 4.5). In addition, two infants delivered by ERCS developed respiratory distress syndrome. Infants delivered after a TOL had increased rates of suspected and proven sepsis (5% vs 2% and 1% vs 0.1%, respectively).

Compared with a successful TOL, the infants delivered by cesarean section after a failed TOL had more neonatal morbidity and had a longer hospital stay (4.8 ± 2 vs 3.1 ± 2 days). The odds ratio for developing any respiratory illness after a failed TOL was 2.1 (95% CI: 1.1, 4.1), for suspected sepsis was 4.8 (95% CI: 2.6, 9.0), and for proven sepsis was 19.3 (95% CI: 2.0, 187). Neonatal outcomes after a successful TOL were similar to routine vaginal births.

Conclusion.  Infants born by ERCS are at increased risk for developing respiratory problems compared with those born by TOL. However, TOL is associated with increased rates of suspected and proven sepsis. This appears to be limited to infants delivered by cesarean section after a failed TOL.

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