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Neonatal outcomes after elective cesarean delivery.
Beena D Kamath1, James K Todd, Judith E Glazner
1From the Departments of Pediatrics, Section of Neonatology, and Obstetrics and Gynecology, University of Colorado School of Medicine; Department of Infectious Disease and Epidemiology, the Children's Hospital, Denver; and Colorado School of Public Health, Denver, Colorado.
Elective repeat cesarean delivery leads to higher neonatal intensive care unit (NICU) admission and respiratory issues compared to vaginal birth after cesarean (VBAC). VBAC is also more cost-effective, though failed VBAC incurs higher costs.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Health
- Health Economics
Background:
- Women with a prior cesarean delivery face delivery choices: elective repeat cesarean or vaginal birth after cesarean (VBAC).
- Understanding neonatal outcomes and costs associated with each delivery method is crucial for clinical and economic decision-making.
Purpose of the Study:
- To compare neonatal outcomes, specifically neonatal intensive care unit (NICU) admission and respiratory morbidity, between elective repeat cesarean delivery and VBAC.
- To evaluate the economic differences between elective repeat cesarean delivery and VBAC.
Main Methods:
- A retrospective cohort study included 672 women with one prior cesarean delivery and singleton pregnancies at term.
- Women were categorized based on their planned delivery: elective repeat cesarean or VBAC (successful or failed).
- Primary outcomes included NICU admission and respiratory morbidity; cost analysis was also performed.
Main Results:
- Neonates from elective repeat cesarean deliveries showed higher NICU admission rates (9.3% vs. 4.9%) and increased need for oxygen supplementation during resuscitation and after NICU admission compared to the VBAC group.
- While elective repeat cesarean was more expensive than VBAC, failed VBAC resulted in the highest overall birth experience costs, including delivery and NICU utilization.
- VBAC neonates required the least delivery room resuscitation, whereas those from failed VBAC required the most.
Conclusions:
- Neonates born via elective repeat cesarean delivery experience significantly higher rates of respiratory morbidity and NICU admission compared to those born via VBAC.
- Elective repeat cesarean delivery is associated with longer hospital stays for neonates.
- VBAC presents a potentially safer and more cost-effective option for neonates when compared to elective repeat cesarean delivery, although failed VBAC carries significant costs.
