Objective: To determine whether there is an increased incidence of persistent pulmonary hypertension in neonates delivered by cesarean, with or without labor, compared with those delivered vaginally.
Methods: We did a computerized retrospective review of 29,669 consecutive deliveries over 7 years (1992–1999). The incidences of persistent pulmonary hypertension of the newborn, transient tachypnea of the newborn, and respiratory distress syndrome (RDS) were tabulated for each delivery mode. Cases of persistent pulmonary hypertension were reviewed individually to determine delivery method and whether labor had occurred. The three groups defined were all cesarean deliveries, all elective cesareans, and all vaginal deliveries.
Results: Among 4301 cesareans done, 17 neonates had persistent pulmonary hypertension (four per 1000 live births). Among 1889 elective cesarean deliveries, seven neonates had persistent pulmonary hypertension (3.7 per 1000 live births). Among 21,017 vaginal deliveries, 17 neonates had persistent pulmonary hypertension (0.8 per 1000 live births). χ2 analysis showed an odds ratio 4.6 and P < .001 for comparison of elective cesarean and vaginal delivery for that outcome.
Conclusion: The incidence of persistent pulmonary hypertension of the newborn was approximately 0.37% among neonates delivered by elective cesarean, almost fivefold higher than those delivered vaginally. The findings have implications for informed consent before cesarean and increased surveillance of neonates after cesarean.
Persistent pulmonary hypertension of the newborn, formerly referred to as persistent fetal circulation, is a life-threatening problem in neonates. In 1977, Maisels et al1 reported an association between elective repeat cesarean delivery and respiratory distress syndrome (RDS). In another report, investigators found an increased risk of general respiratory problems, including transient tachypnea of the newborn and RDS, in neonates delivered after elective repeat cesareans, compared with those delivered after a trial of labor.2 A case-controlled analysis of neonates who required extracorporeal membrane oxygenation specifically found an association of persistent pulmonary hypertension with elective cesarean delivery.3 Two other reports also linked persistent pulmonary hypertension to elective cesarean,4,5 but they had a limited number of deliveries. Cesarean delivery also was associated with persistent pulmonary hypertension of the newborn and with other antepartum variables.6 To confirm that association and to expand on it with more cases, we retrospectively analyzed our perinatal database of 29,669 consecutive deliveries with regard to a possible association between delivery mode and incidence of persistent pulmonary hypertension of the newborn, transient tachypnea of the newborn, and RDS.
Cesarean delivery increases the risk of persistent pulmonary hypertension, transient tachypnea, and respiratory distress syndrome in neonates.
Departments of Obstetrics & Gynecology and Pediatrics, Illinois Masonic Medical Center, Chicago, Illinois.
Elliot M. Levine, MD, Department of Obstetrics and Gynecology, Illinois Masonic Medical Center, 836 West Wellington, Chicago, IL 60657; E-mail: firstname.lastname@example.org
Received June 28, 2000. Received in revised form October 2, 2000. Accepted October 19, 2000.