Neonatal Outcomes After Elective Cesarean Delivery

Abstract

OBJECTIVE: To examine the outcomes of neonates born by elective repeat cesarean delivery compared with vag-inal 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 mor-bidity. 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 re-suscitation (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 neo-nates delivered after failed VBAC required the greatest degree of delivery room resuscitation. The costs of elec-tive repeat cesarean were significantly greater than VBAC. However, failed VBAC accounted for the most expensive total birth experience (delivery and NICU use). CONCLUSION: 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.