Rising Cesarean Rate Bad for Mothers and Babies
Top 12 Studies from 2008
1.
Asthma at 8 years of age in children
born by cesarean section.
(Roduit, et at., Thorax. Epub, 3 December)
Study
Design: Researchers
assessed the relationship between childhood respiratory disease and cesarean section.
Bottom
Line: Children born by cesarean section to
non-allergic parents have a 2.14 times higher risk of asthma than those born by
vaginal delivery
2.
Cesarean birth in the
United States: epidemiology, trends and
outcomes.
(MacDorman, et al., Clin
Perinatol. 35(2):293-307, June)
Study Design: Researchers
analyzed data describing cesarean births.
Bottom Line: Both
primary and repeat cesareans have increased. Increases in non-medically
indicated primary cesareans have been more rapid than in the overall population
and seem the result of changes in obstetric practice rather than changes in the
medical risk profile or increases in "maternal request."
3.
Increased risk of stroke in patients
who undergo cesarean section delivery: a nationwide population-based study. (Lin, et al., Am J Obstet Gynecol.
198(4):391.e1-7, 14 Feb)
Study
Design: Researchers
examined population data to determine if cesarean sections increase the risk of
stroke.
Bottom
Line: At 3, 6, and 12 months after delivery, rates of
stroke among the mothers were 67 percent, 61 percent, and 49 percent higher,
respectively, following cesarean rather than vaginal birth. Cesarean section delivery is an
independent risk factor for stroke.
4.
Safety and efficacy of external
cephalic version for women with a previous cesarean delivery. (Sela, et al., Eur J Obstet Gynecol
Reprod Biol, Epub, 17 November)
Study
Design: Researchers
evaluated the success and complications after external cephalic version for
breech position in women with one previous cesarean.
Bottom
Line: The success
rate was 74%, and 84% of women with successful versions delivered vaginally.
There were no negative outcomes for any of the women or babies. Women with a
breech baby and a previous cesarean should be informed about the success and
safety of this procedure.
5.
Perinatal outcomes in the setting of
active phase arrest of labor.
(Henry, et al., Obstet Gynecol. 112(5):1109-15, November)
Study
Design: Researchers
compared outcomes of cesarean delivery vs. vaginal delivery in women with
stalled labor.
Bottom
Line: Cesarean
delivery was associated with an increased risk of chorioamnionitis,
endomyometritis, postpartum hemorrhage , and severe postpartum hemorrhage.
There were no differences in complications with babies. Among women who
delivered vaginally, women with a stalled labor had significantly increased
odds of chorioamnionitis and shoulder dystocia. However, there were no differences in the
serious problems associated with these outcomes. Efforts to achieve vaginal delivery in the
setting of active phase arrest may reduce the maternal risks associated with
cesarean delivery without additional risk to the baby.
6.
Physician financial incentives and
cesarean delivery: New conclusions from
the healthcare cost and utilization project. (Grant, J Heath Econ. Epub 2 October)
Study
Design: Researcher analyzed the relationship between
physician fees and the number of cesareans performed.
Bottom
Line: Analysis indicates that an increase of $1000
in the reimbursement for a cesarean section increases the rate of cesarean
delivery by about 1%.
7.
Can a prediction model for vaginal
birth after cesarean also predict the probability fo morbidity related to a
trial of labor? (Grobman,
et al., Am J Obstet Gynecol Epub 24 2008)
Study
Design: Researchers determined whether predicting the
likelihood of a VBAC was effective in predicting the likelihood of morbidity
associated with a trial of labor.
Bottom
Line: If the chance of a successful VBAC is
estimated at 70% or better, then the likelihood of complications in the mother
is the same as with an elective repeat cesarean. The results were the same for the likelihood
of complications in the baby as well.
8.
Maternal morbidity following a trial
of labor after cesarean section vs elective repeat cesarean delivery: a
systematic review with metaanalysis. (Rossi, Am J Obstet Bynecol. 199(3):224-31,
September)
Study
Design: Researchers reviewed maternal complications
following trial of labor after cesarean section, compared with elective repeat
cesarean delivery.
Bottom
Line: VBAC was successful 73% of the time. Maternal
morbidity, blood transfusion, and hysterectomy were similar in women planning
VBAC or repeat cesarean. Maternal
morbidity, uterine rupture/dehiscence, blood transfusion and hysterectomy were
more common after a failed trial of labor than after a successful VBAC or
repeat cesarean but outcomes were more favorable after a successful VBAC than
repeat cesarean. These findings show that a higher risk of uterine
rupture/dehiscence in women planning VBAC is counterbalanced by a reduction of maternal
morbidity, uterine rupture/dehiscence and hysterectomy when VBAC is successful.
9.
Suspected macrosomia? Better not
tell. (Sadeh-Mestechkin,
et al., Arch Gynecol Obstet. 287(3):225-30, September)
Study
Design: Researchers reviewed records of women with
suspected macrosomia compared to all women who gave birth during the same time
frame.
Bottom
Line: Induction of labor and cesarean delivery
rates in the macrosomic pregnancies (actual birth weight >4,000 g) of the
study group were significantly higher than the macrosomic pregnancies in the
comparison group. No significant difference
was seen in maternal or infant complications when comparing non-macrosomic
pregnancies to macrosomic pregnancies in the suspected macrosomia group. The ability to predict macrosomia is poor.
The management policy of suspected macrosomic pregnancies raises induction of
labor and cesarean delivery rates without improving maternal or fetal outcome.
10. Placenta
accreta and cesarean scar pregnancy: overlooked costs of the rising cesarean
section rate. (Rosen,
Clin Perinatol. 35(3):519-29, September)
Study
Design: Author reviewed theories on abnormal
placentation.
Bottom
Line: The rising cesarean rate has resulted in an
increase in placenta accreta and cesarean scar pregnancy which are associated
with high rates of maternal morbidity and mortality. Improvements in management and future
research to reduce the incidence of the potentially devastating complication
are necessary.
11. Vaginal
birth after cesarean delivery. (Landon, Clin Perinatol. 35(3):491-504,
September)
Study
Design: Author reviewed incidence of and
complications associated with VBAC.
Bottom
Line: By 2004, only 9.2% of women in the United
States with prior cesareans underwent a trial of labor, although nearly two
thirds of these women were candidates for a trial of labor. Women with prior cesarean deliveries are at
risk for maternal and perinatal complications, whether undergoing a trial of
labor or choosing elective repeat cesarean section. Complications of both
procedures should be discussed and an attempt made to individualize the risks
of repeat cesarean and the likelihood of successful VBAC for each woman.
12. Cesarean
delivery may affect the early biodiversity of intestinal bacteria. (Biasucci, J Nutr.
138(9):1796S-1800S, September)
Study
Design: Researchers evaluated the relationship between
the intestinal bacteria of the newborn and mode of delivery.
Bottom
Line: The intestines of newborns are colonized
immediately after birth with bacteria, mainly from the mother. There is strong evidence suggesting that the
type of bacteria plays an important role in the development of the immune
system. The intestinal bacteria of infants delivered by cesarean delivery
appear to be less diverse than the bacteria of vaginally delivered
infants. The mode of delivery has a deep
impact on the composition of the intestinal bacteria at the very beginning of
human life.