OBJECTIVE: To examine the outcomes of neonates born by elective repeat cesarean delivery compared with vaginal 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 morbidity.
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 resuscitation (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 neonates delivered after failed VBAC required the greatest degree of delivery room resuscitation. The costs of elective 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.
LEVEL OF EVIDENCE: II
Neonates born after elective repeat cesarean delivery have significantly higher rates of respiratory morbidity and neonatal intensive care unit admission and longer length of hospital stay.
From the Departments of 1Pediatrics, Section of Neonatology, and 2Obstetrics and Gynecology, University of Colorado School of Medicine; 3Department of Infectious Disease and Epidemiology, the Children’s Hospital, Denver; and 4Colorado School of Public Health, Denver, Colorado.
The authors thank Jocelyn Seelye, BS, Jan Hart, MPH, and Sarah Crowley, BA, for being the Research Assistants for the Perinatal Database.
Corresponding author: Beena D. Kamath, MD, MPH, Mail Stop 8402, Education 2 South, Room 4304, 13121 East 17th Avenue, PO Box 6508, Aurora, CO 80045; e-mail: Beena.Kamath@ucdenver.edu.
Financial Disclosure The authors did not report any potential conflicts of interest.