Skip Navigation LinksHome > March 2001 - Volume 97 - Issue 3 > Mode of Delivery and Risk of Respiratory Diseases in Newborn...
Obstetrics & Gynecology:
Original Research

Mode of Delivery and Risk of Respiratory Diseases in Newborns

LEVINE, ELLIOT M. MD; GHAI, VIVEK MD; BARTON, JOHN J. MD; STROM, CHARLES M. MD, PhD

Free Access
Article Outline
Collapse Box

Author Information

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: infodoc@immc.org

Received June 28, 2000. Received in revised form October 2, 2000. Accepted October 19, 2000.

Collapse Box

Abstract

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.

Back to Top | Article Outline

Materials and Methods

We did a computerized retrospective review of 29,669 consecutive women who delivered at Illinois Masonic Medical Center between January 1, 1992 and December 31, 1999. Deliveries were grouped by delivery route and whether labor had occurred (all cesareans, elective cesareans, and all vaginal deliveries). Our perinatal database consists of information entered in a custom computer program each day by a chart abstractor, based on what providers write on the Hollister Labor and Delivery Summary Form for each delivery. The database was searched specifically for all cases of persistent pulmonary hypertension, transient tachypnea, and RDS, and the chart for each selected case was reviewed. Diagnoses of persistent pulmonary hypertension by our neonatologists were based on presence of right-to-left shunting at the the ductus arteriosus, foramen ovale, or both, documented by echocardiography or a significant pre- to postductal partial oxygen tension (pO2) gradient; the need for 100% oxygen to maintain arterial oxygenation between 60 and 70 mmHg; and no structural heart disease as determined by echocardiography. Diagnoses of transient tachypnea of the newborn were based on tachypnea that was relieved by minimal oxygen therapy (ie, < 40% oxygen) and chest X-ray showing prominent pulmonary vascular markings. Diagnoses of RDS were based on hypoxemia and acidosis, and chest X-ray findings of hyaline membrane disease (eg, a reticulogranular pattern). Only singleton live newborns were included. To limit the review to circumstances in which persistent pulmonary hypertension was most likely (at or near term), cases were excluded for one or more confounding variables, including pre-term delivery (gestational age less than 35 weeks), congenital heart disease, congenital diaphragmatic hernia, or meconium aspiration syndrome. χ2 analysis was done for statistical comparisons between the combined cesarean group and the vaginal delivery group, and between the elective cesarean group and the vaginal delivery group, for incidences of persistent pulmonary hypertension of the newborn, transient tachypnea of the newborn, and RDS. P values, odds ratios (ORs), and 95% confidence intervals (CIs) were calculated using Simple Interactive Statistical Analysis online (http://Home.Clara.net/SISA/index.htm).

Back to Top | Article Outline

Results

Among 29,669 deliveries at our institution from 1992–1999, 25,318 met the inclusion criteria. Table 1 is a compilation of data and statistical analyses from that cohort. There were 4301 cesareans (17%), and of those 1889 were elective. Seven hundred thirty-five scheduled cesareans were for breech presentation, placenta previa, genital herpes, macrosomia, or multiple gestation; the rest of the elective cesareans (1154) were done because of prior cesareans. During that period, 34 neonates (1.3 per 1000 live births) had primary diagnoses of persistent pulmonary hypertension of the newborn. Analysis showed that among 4301 cesareans, 17 resulted in the delivery of neonates who were admitted to the neonatal intensive care unit (NICU) and subsequently discharged with primary diagnoses of persistent pulmonary hypertension of the newborn (4.0 per 1000 live births). Among 1889 elective cesareans, seven resulted in neonates admitted to the NICU with persistent pulmonary hypertension (3.7 per 1000 live births). Among 21,017 vaginal deliveries at term, 17 resulted in neonates with persistent pulmonary hypertension (0.8 per 1000 live births).

Table 1
Table 1
Image Tools

Six neonates with persistent pulmonary hypertension were transferred to other institutions for therapy. No follow-up was available for them, but it is likely that some of them have died; therefore, we are unable to report accurately the mortality rate of persistent pulmonary hypertension in our population.

The combined incidence of all three respiratory problems in neonates delivered by cesarean was 4.5% compared with 1.4% of vaginally delivered neonates. The difference between incidences of respiratory diagnoses in the elective cesarean group (4.2%) compared with those of the vaginally delivered neonates was similar.

Back to Top | Article Outline

Discussion

The incidence of persistent pulmonary hypertension of the newborn was one in 270 among newborns delivered by elective cesarean, a rate almost fivefold higher than that for neonates delivered vaginally. It is apparent that risk of transient tachypnea or RDS is greater than that of persistent pulmonary hypertension, but the risk of persistent pulmonary hypertension has a remarkably greater mortality rate.6,7 The risk of persistent pulmonary hypertension (about one in 1000 deliveries)6 was less than the incidence most often quoted for uterine rupture during a trial of labor after cesarean, from .07% to 1.3%.8,9 The neonatal mortality rate for uterine rupture during labor after cesarean did not exceed that without uterine rupture (about nine in 1000 live births),10 and therefore should be considered somewhat less than that for persistent pulmonary hypertension. McMahon et al11 showed that perinatal mortality rates did not differ between those born by elective repeat cesarean and those born after trials of labor. In our series, most elective cesareans were performed because of previous cesareans. In those cases, there were no conditions that threatened the fetuses, such as fetal bradycardia or abruptia placentae; therefore, labor and vaginal delivery could have been considered. That contrasts with cesareans after labor in which potential for harm existed.

There has been much discussion of methods to prevent group B streptococcal neonatal sepsis, the incidence of which has been reported as one to two per 1000 deliveries,12 a rate similar to that reported for persistent pulmonary hypertension (one per 1000 deliveries). Current obstetric standards recommend intrapartum chemoprophylaxis, particularly for perinates at risk of group B streptococcal sepsis, so it appears that neonates delivered by cesarean are at risk of acquiring persistent pulmonary hypertension. Although recent studies have reported promising results of extracorporeal membrane oxygenation and inhaled nitric oxide for treating persistent pulmonary hypertension, prevention of elective cesarean might greatly reduce mortality rates for that condition.

Respiratory conditions that prompted admission to the NICU (ie, persistent pulmonary hypertension and transient tachypnea) were almost threefold greater in the elective cesarean group than among vaginally delivered neonates, despite their having no conditions that threatened fetuses. Our findings confirm the risk of NICU-related morbidity for elective cesarean delivery. A report by Rawling and Smith13 did not identify elective cesarean as a risk factor, but they had fewer deliveries. Incidence of RDS in the elective cesarean group was similar to that in the vaginally delivered group. Our study design could not differentiate between cesarean delivery itself as a risk factor for persistent pulmonary hypertension or transient tachypnea, or the absence of labor, or both.

A likely hypothesis for persistent pulmonary hypertension after cesarean is that there might be an advantage to labor and vaginal delivery for the pulmonary vascular bed of the neonate. That hypothesis is supported by the finding that the interval of physiologic transient pulmonary hypertension after delivery was prolonged in neonates delivered by cesarean.14 Those neonatal circulatory differences were also shown by echocardiography by Jacobstein et al.15 Sulyak and Csaba16 postulated that the low rate of endogenous prostaglandin production during elective cesarean might be responsible for the high pulmonary hypoperfusion leading to persistent pulmonary hypertension. The mechanism of that advantage provided by vaginal delivery is not known. The physical compression of the perinate in the birth canal might be an additional potential benefit.

The prevalence of cesarean deliveries has remained stable during the past decade.17 There is a general belief in the obstetric community that cesareans result in improved perinatal outcomes. Few if any neonatal risks have been associated with cesarean delivery. Informed consent for cesareans focuses on maternal consequences. We confirmed and quantified the association of cesarean and neonatal risk of persistent pulmonary hypertension, and we expanded the risk to include cesarean after labor, which should be considered with any cesarean in which labor could otherwise occur safely. It is equally important to discuss such neonatal risk when offering a woman delivery options, in view of obstetricians' medicolegal obligations of informed consent.

Many cases of persistent pulmonary hypertension might be prevented with prompt and aggressive use of oxygen desaturations. Vigilant monitoring of neonates delivered by cesarean, especially elective cesareans, might prevent the high morbidity and mortality rates associated with persistent pulmonary hypertension.

Back to Top | Article Outline

References

1. Maisels MJ, Rees R, Marks K, Friedman Z. Elective delivery of the term fetus. JAMA 1977;238:2036–9.

2. Hook B, Kiwi R, Amini SB, Faranoff A, Hack M. Neonatal morbidity after elective repeat cesarean section and trial of labor. Pediatrics 1997;100:348–53.

3. Keszler M, Carbone MT, Cox C, Schumacher RE. Severe respiratory failure after elective repeat cesarean delivery: A potentially preventable condition leading to extracorporeal membrane oxygenation. Pediatrics 1992;89:670–2.

4. Heritage CK, Cunningham MD. Association of elective repeat cesarean delivery and persistent pulmonary hypertension of the newborn. Am J Obstet Gynecol 1985;152:627–9.

5. Leder ME, Hirschfeld S, Fanaroff A. Persistent fetal circulation: An epidemiologic study. Pediatr Res 1980;14:490.

6. Reece EA, Moya F, Yazigi R, Holford T, Duncan C, Ehrenkranz RA. Persistent pulmonary hypertension: Assessment of perinatal risk factors. Obstet Gynecol 1987;70:696–700.

7. Steinhorn RH, Millard SL, Morin FC III. Persistent pulmonary hypertension of the newborn: Role of nitric oxide and endothelin in pathophysiology and treatment. Clin Perinatol 1995;22:405–28.

8. Gregory KD, Korst LM, Cane P, Platt LD, Kahn K. Vaginal birth after cesarean and uterine rupture rates in California. Obstet Gynecol 1999;94:985–9.

9. Shipp TD, Zelop CM, Repke JT, Cohen A, Caughey AB, Lieberman E. Intrapartum uterine rupture and dehiscence in patients with prior lower uterine segment vertical and transverse incisions. Obstet Gynecol 1999;94:735–40.

10. Rosen MG, Dickinson JC, Westhoff CL. Vaginal birth after cesarean: A meta-analysis of morbidity and mortality. Obstet Gynecol 1991;77:465–70.

11. McMahon MJ, Luther ER, Bowes WA Jr, Olshan AF. Comparison of a trial of labor with an elective second cesarean section. N Engl J Med 1996;335:689–95.

12. American College of Obstetricians and Gynecologists. Group B streptococcal infections in pregnancy. ACOG technical bulletin no. 170. Washington DC: American College of Obstetricians and Gynecologists, 1992.

13. Rawlings JS, Smith FR. Transient tachypnea of the newborn. An analysis of neonatal and obstetric risk factors. Am J Dis Child 1984;138:869–71.

14. Makihara K, Hata T, Hata K, Kitao M. Echocardiographic assessment of systolic time intervals in vaginal and cesarean delivered neonates. Am J Perinatol 1993;10:53–7.

15. Jacobstein MD, Hirschfeld SS, Flinn C, Riggs T, Fanaroff A. Neonatal circulatory changes following elective cesarean section: An echocardiographic study. Pediatrics 1982;69:374–6.

16. Sulyok L, Csaba LF. Elective repeat cesarean delivery and persistent pulmonary hypertension of the newborn. Am J Obstet Gynecol 1986;155:687–8.

17. Menard MK. Cesarean delivery rates in the United States. The 1990s. Obstet Gynecol Clin North Am 1999;26:275–86.

Cited By:

This article has been cited 92 time(s).

Geburtshilfe Und Frauenheilkunde
Neonatal Transfer Rate and Mode of Delivery from 37th Week of Gestation in a German Perinatal Center Level 1
Reinhard, J; Hanker, L; Sanger, N; Yuan, J; Louwen, F
Geburtshilfe Und Frauenheilkunde, 73(4): 324-329.
10.1055/s-0032-1328435
CrossRef
Best Practice & Research Clinical Obstetrics & Gynaecology
Caesarean section on maternal request for non-medical reasons: Putting the UK National Institute of Health and Clinical Excellence guidelines in perspective
D'Souza, R
Best Practice & Research Clinical Obstetrics & Gynaecology, 27(2): 165-177.
10.1016/j.bpobgyn.2012.09.006
CrossRef
American Journal of Obstetrics and Gynecology
Cesarean section and development of the immune system in the offspring
Cho, CE; Norman, M
American Journal of Obstetrics and Gynecology, 208(4): 249-254.
10.1016/j.ajog.2012.08.009
CrossRef
Pediatrics
Nonsteroidal Antiinflammatory Drugs in Late Pregnancy and Persistent Pulmonary Hypertension of the Newborn
Van Marter, LJ; Hernandez-Diaz, S; Werler, MM; Louik, C; Mitchell, AA
Pediatrics, 131(1): 79-87.
10.1542/peds.2012-0496
CrossRef
Archives of Cardiovascular Diseases
Pathophysiology of persistent pulmonary hypertension of the newborn: Impact of the perinatal environment
Storme, L; Aubry, E; Rakza, T; Houeijeh, A; Debarge, V; Tourneux, P; Deruelle, P; Pennaforte, T
Archives of Cardiovascular Diseases, 106(3): 169-177.
10.1016/j.acvd.2012.12.005
CrossRef
Health Affairs
Cesarean Delivery Rates Vary Tenfold Among US Hospitals; Reducing Variation May Address Quality And Cost Issues
Kozhimannil, KB; Law, MR; Virnig, BA
Health Affairs, 32(3): 527-535.
10.1377/hlthaff.2012.1030
CrossRef
Plos One
Caesarean Delivery and Subsequent Stillbirth or Miscarriage: Systematic Review and Meta-Analysis
O'Neill, SM; Kearney, PM; Kenny, LC; Khashan, AS; Henriksen, TB; Lutomski, JE; Greene, RA
Plos One, 8(1): -.
ARTN e54588
CrossRef
Journal of Maternal-Fetal & Neonatal Medicine
A comparative study of neonatal outcomes in placenta previa versus cesarean for other indication at term
Schneiderman, M; Balayla, J
Journal of Maternal-Fetal & Neonatal Medicine, 26(): 1121-1127.
10.3109/14767058.2013.770465
CrossRef
Prenatal Diagnosis
Prenatal diagnosis of congenital heart disease: impact of mode of delivery on neonatal outcome
Trento, LU; Pruetz, JD; Chang, RK; Detterich, J; Sklansky, MS
Prenatal Diagnosis, 32(): 1250-1255.
10.1002/pd.3991
CrossRef
Acta Psychiatrica Scandinavica
Antidepressant use in pregnancy: a critical review focused on risks and controversies
Byatt, N; Deligiannidis, KM; Freeman, MP
Acta Psychiatrica Scandinavica, 127(2): 94-114.
10.1111/acps.12042
CrossRef
Paediatric Respiratory Reviews
Respiratory Distress of the Term Newborn Infant
Edwards, MO; Kotecha, SJ; Kotecha, S
Paediatric Respiratory Reviews, 14(1): 29-37.
10.1016/j.prrv.2012.02.002
CrossRef
Journal of Allergy and Clinical Immunology
Mode of delivery and risk of allergic rhinitis and asthma
Bager, P; Melbye, M; Rostgaard, K; Benn, CS; Westergaard, T
Journal of Allergy and Clinical Immunology, 111(1): 51-56.
10.1067/mai.2003.34
CrossRef
American Journal of Obstetrics and Gynecology
Unnecessary cesarean delivery in Louisiana: An analysis of birth certificate data
Kabir, AA; Steinmann, WC; Myers, L; Khan, MM; Herrera, EA; Yu, SK; Jooma, N
American Journal of Obstetrics and Gynecology, 190(1): 10-19.
10.1016/j.ajog.2003.07.009
CrossRef
American Journal of Perinatology
Cesarean section, gestational age, and transient tachypnea of the newborn: Timing is the key
Riskin, A; Abend-Weinger, M; Riskin-Mashiah, S; Kugelman, A; Bader, D
American Journal of Perinatology, 22(7): 377-382.
10.1055/s-2005-872594
CrossRef
Pediatrics
Risk factors for persistent pulmonary hypertension of the newborn
Hernandez-Diaz, S; Van Marter, LJ; Werler, MM; Louik, C; Mitchell, AA
Pediatrics, 120(2): E272-E282.
10.1542/peds.2006-3037
CrossRef
American Family Physician
Respiratory distress in the newborn
Hermansen, CL; Lorah, KN
American Family Physician, 76(7): 987-994.

Cadernos De Saude Publica
Apgar score associated with mode of delivery in Sao Paulo State, Brazil
Kilsztajn, S; Lopes, EDS; do Carmo, MSN; Reyes, AMD
Cadernos De Saude Publica, 23(8): 1886-1892.

Archives of Disease in Childhood-Fetal and Neonatal Edition
Neonatal outcomes with caesarean delivery at term
Liston, FA; Allen, VM; O'Connell, CM; Jangaard, KA
Archives of Disease in Childhood-Fetal and Neonatal Edition, 93(3): F176-F182.
10.1136/adc.2006.112565
CrossRef
Archives of Disease in Childhood
Maternal intravaginal prostaglandin E-2 gel before elective caesarean section at term to induce catecholamine surge in cord blood: randomised, placebo controlled study
Singh, M; Patole, S; Rane, A; Naidoo, D; Buettner, P
Archives of Disease in Childhood, 89(2): 131-135.
10.1136/adc.2002.025957
CrossRef
Journal of Midwifery & Womens Health
Elective cesarean birth: Issues and ethics of an informed decision
McFarlin, BL
Journal of Midwifery & Womens Health, 49(5): 421-429.

Clinical and Experimental Allergy
A meta-analysis of the association between Caesarean section and childhood asthma
Thavagnanam, S; Fleming, J; Bromley, A; Shields, MD; Cardwell, CR
Clinical and Experimental Allergy, 38(4): 629-633.
10.1111/j.1365-2222.2007.02780.x
CrossRef
Seminars in Perinatology
VBAC - Is it worth the risk?
Socol, ML
Seminars in Perinatology, 27(1): 105-111.
10.1053/sper.2003.50008
CrossRef
Canadian Medical Association Journal
Elective cesarean section
Klein, MC
Canadian Medical Association Journal, 171(1): 14-15.
10.1503/cmaj.1040516
CrossRef
American Journal of Obstetrics and Gynecology
Neonatal impact of elective repeat cesarean delivery at term: A comment on patient choice cesarean delivery
Fogelson, NS; Menard, MK; Hulsey, T; Ebeling, M
American Journal of Obstetrics and Gynecology, 192(5): 1433-1436.
10.1016/j.ajog.2005.01.010
CrossRef
Birth-Issues in Perinatal Care
Infant and neonatal mortality for primary Cesarean and vaginal births to women with "No indicated risk," United States, 1998-2001 birth cohorts
MacDorman, MF; Declercq, E; Menacker, F; Malloy, MH
Birth-Issues in Perinatal Care, 33(3): 175-182.

New England Journal of Medicine
Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes
Tita, ATN; Landon, MB; Spong, CY; Lai, YL; Leveno, KJ; Varner, MW; Moawad, AH; Caritis, SN; Meis, PJ; Wapner, RJ; Sorokin, Y; Miodovnik, M; Carpenter, M; Peaceman, AM; O'Sullivan, MJ; Sibai, BM; Langer, O; Thorp, JM; Ramin, SM; Mercer, BM
New England Journal of Medicine, 360(2): 111-U29.

Pharmacoepidemiology and Drug Safety
Antidepressant medication use and risk of persistent pulmonary hypertension of the newborn
Andrade, SE; McPhillips, H; Loren, D; Raebel, MA; Lane, K; Livingston, J; Boudreau, DM; Smith, DH; Davis, RL; Willy, ME; Platt, R
Pharmacoepidemiology and Drug Safety, 18(3): 246-252.
10.1002/pds.1710
CrossRef
Cochrane Database of Systematic Reviews
Corticosteroids for preventing neonatal respiratory morbidity after elective caesarean section at term
Sotiriadis, A; Makrydimas, G; Papatheodorou, S; Ioannidis, JPA
Cochrane Database of Systematic Reviews, (4): -.
ARTN CD006614
CrossRef
Journal of Perinatology
Previous cesarean section and the risk of postpartum maternal complications and adverse neonatal outcomes in future pregnancies
Galyean, AM; Lagrew, DC; Bush, MC; Kurtzman, JT
Journal of Perinatology, 29(): 726-730.
10.1038/jp.2009.108
CrossRef
Gynecologie Obstetrique & Fertilite
Obstetrical management of women with previous caesarean section
Poulain, P; Seconda, S
Gynecologie Obstetrique & Fertilite, 38(1): 48-57.
10.1016/j.gyobfe.2009.11.016
CrossRef
New England Journal of Medicine
Elective primary cesarean delivery
Sheldon, RE; Escobedo, MB
New England Journal of Medicine, 348(): 2364.

New England Journal of Medicine
Elective primary cesarean delivery - Reply
Minkoff, H; Chervenak, FA
New England Journal of Medicine, 348(): 2365.

Acta Paediatrica
Elective caesarean section increases the risk of respiratory morbidity of the newborn
Borgwardt, L; Bach, D; Nickelsen, C; Gutte, H; Boerch, K
Acta Paediatrica, 98(1): 187-189.
10.1111/j.1651-2227.2008.01054.x
CrossRef
Journal of Perinatal Medicine
Use and abuse of cesarean section - a transatlantic evaluation
Schmidt, S
Journal of Perinatal Medicine, 37(5): 565-568.
10.1515/JPM.2009.113
CrossRef
Journal of Womens Health
Pelvic Floor Consequences of Cesarean Delivery on Maternal Request in Women with a Single Birth: A Cost-effectiveness Analysis
Xu, X; Ivy, JS; Patel, DA; Patel, SN; Smith, DG; Ransom, SB; Fenner, D; DeLancey, JOL
Journal of Womens Health, 19(1): 147-160.
10.1089/jwh.2009.1404
CrossRef
Swiss Medical Weekly
Respiratory distress syndrome in near-term babies after caesarean section
Roth-Kleiner, M; Wagner, BP; Bachmann, D; Pfenninger, J
Swiss Medical Weekly, 133(): 283-288.

American Family Physician
Patient-choice cesarean delivery
Leeman, L
American Family Physician, 72(4): 697-+.

Birth-Issues in Perinatal Care
Admission of term infants to neonatal intensive care: A population-based study
Tracy, SK; Tracy, MB; Sullivan, E
Birth-Issues in Perinatal Care, 34(4): 301-307.

American Journal of Epidemiology
Perinatal factors and the risk of asthma in childhood - A population-based register study in Finland
Metsala, J; Kilkkinen, A; Kaila, M; Tapanainen, H; Klaukka, T; Gissler, M; Virtanen, SM
American Journal of Epidemiology, 168(2): 170-178.
10.1093/aje/kwn105
CrossRef
Bjog-An International Journal of Obstetrics and Gynaecology
There is still room for disagreement about vaginal delivery of breech infants at term
van Roosmalen, J; Rosendaal, F
Bjog-An International Journal of Obstetrics and Gynaecology, 109(9): 967-969.
PII S1470-0328(02)01705-6
CrossRef
West Indian Medical Journal
Acute respiratory disorders in the newborn - The lessons to be learnt
Antoine, MG
West Indian Medical Journal, 52(1): 1-3.

Journal of Pediatric Surgery
Routine cesarean delivery does not improve the outcome of infants with gastroschisis
Puligandla, PS; Janvier, A; Flageole, H; Bouchard, S; Laberge, JM
Journal of Pediatric Surgery, 39(5): 742-745.
10.1016/j.jpedsurg.2004.01.042
CrossRef
Annals of Epidemiology
Mode of delivery is associated with asthma and allergy occurrences in children
Salam, MT; Margolis, HG; McConnell, R; McGregor, JA; Avol, EL; Gilliland, FD
Annals of Epidemiology, 16(5): 341-346.
10.1016/j.annepidem.2005.06.054
CrossRef
Clinics in Perinatology
Late preterm infants, early term infants, and timing of elective deliveries
Engle, WA; Kominiarek, MA
Clinics in Perinatology, 35(2): 325-+.
10.1016/j.clp.2008.03.003
CrossRef
Clinics in Perinatology
Elective cesarean section: Its impact on neonatal respiratory outcome
Ramachandrappa, A; Jain, L
Clinics in Perinatology, 35(2): 373-+.
10.1016/j.clp.2008.03.006
CrossRef
Acta Obstetricia Et Gynecologica Scandinavica
Changed indications for cesarean sections
Stjernholm, YV; Petersson, K; Eneroth, E
Acta Obstetricia Et Gynecologica Scandinavica, 89(1): 49-53.
10.3109/00016340903418777
CrossRef
American Journal of Obstetrics and Gynecology
Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: a 7-year retrospective analysis of a national registry
Wilmink, FA; Hukkelhoven, CWPM; Lunshof, S; Mol, BWJ; van der Post, JAM; Papatsonis, DNM
American Journal of Obstetrics and Gynecology, 202(3): -.
ARTN 250.e1
CrossRef
American Journal of Obstetrics and Gynecology
The impact of labor at term on measures of neonatal outcome
Richardson, BS; Czikk, MJ; daSilva, O; Natale, R
American Journal of Obstetrics and Gynecology, 192(1): 219-226.
10.1016/j.ajog.2004.06.034
CrossRef
Pakistan Journal of Medical Sciences
Influence of mode of delivery at term on the neonatal respiratory morbidity
Dehdashtian, M; Riazi, E; Aletayeb, MH
Pakistan Journal of Medical Sciences, 24(4): 556-559.

Journal of Perinatal Medicine
Breech deliveries and cesarean section
Papp, Z
Journal of Perinatal Medicine, 31(5): 415-419.

Annals of Family Medicine
Patient-choice vaginal delivery?
Leeman, LM; Plante, LA
Annals of Family Medicine, 4(3): 265-268.
10.1370/afm.537
CrossRef
Behavioral Neuroscience
Effects of labor contractions on catecholamine release and breathing frequency in newborn rats
Ronca, AE; Abel, RA; Ronan, PJ; Renner, KJ; Alberts, JR
Behavioral Neuroscience, 120(6): 1308-1314.
10.1037/0735-7044.120.6.1308
CrossRef
Social Science & Medicine
Psychosocial sequelae of cesarean delivery: Review and analysis of their causes and implications
Lobel, M; DeLuca, RS
Social Science & Medicine, 64(): 2272-2284.
10.1016/j.socscimed.2007.02.028
CrossRef
British Medical Journal
Endgames Case report A complication after a previous caesarean section
Barrett, N; Sheehan, SR; Murphy, DJ
British Medical Journal, 339(): -.
ARTN b2979
CrossRef
American Journal of Perinatology
The Risk of Acute Neonatal Morbidities in the Delivery Room after Primary Cesarean at Term: Influence of Labor and Stage
Winovitch, KC; Wing, DA; Lagrew, DC; Chung, JH
American Journal of Perinatology, 26(8): 545-551.
10.1055/s-0029-1214240
CrossRef
American Journal of Obstetrics and Gynecology
Once a pregnancy, always a cesarean? Rationale and feasibility of a randomized controlled trial
Ecker, JL
American Journal of Obstetrics and Gynecology, 190(2): 314-318.
10.1016/S0002-9378(03)00869-X
CrossRef
Clinical and Experimental Allergy
Mode of delivery is not associated with asthma or atopy in childhood
Maitra, A; Sherriff, A; Strachan, D; Henderson, J
Clinical and Experimental Allergy, 34(9): 1349-1355.
10.1111/j.1365-2222.2004.02048.x
CrossRef
Seminars in Perinatology
Neonatal mortality and morbidity after elective cesarean delivery versus routine expectant management: A decision analysis
Signore, C; Hemachandra, A; Klebanoff, M
Seminars in Perinatology, 30(5): 288-295.
10.1053/j.semperi.2006.07.010
CrossRef
Journal of Pediatrics
The influence of timing of elective Cesarean section on risk of neonatal pneumothorax
Zanardo, V; Padovani, E; Pittini, C; Doglioni, N; Ferrante, A; Trevisanuto, D
Journal of Pediatrics, 150(3): 252-255.
10.1016/j.jpeds.2006.12.008
CrossRef
Pediatrics
Incidence of Early Neonatal Mortality and Morbidity After Late-Preterm and Term Cesarean Delivery
De Luca, R; Boulvain, M; Irion, O; Berner, M; Pfister, RE
Pediatrics, 123(6): E1064-E1071.
10.1542/peds.2008-2407
CrossRef
Journal of Perinatology
Neonatal outcomes associated with planned vaginal versus planned primary cesarean delivery
Geller, EJ; Wu, JM; Jannelli, ML; Nguyen, TV; Visco, AG
Journal of Perinatology, 30(4): 258-264.
10.1038/jp.2009.150
CrossRef
Pediatric Clinics of North America
An approach to diagnosis and management of cyanosis and tachypnea in term infants
Sasidharan, P
Pediatric Clinics of North America, 51(4): 999-+.
10.1016/j.pcl.2004.03.010
CrossRef
Clinics in Perinatology
Primary nonmedically indicated cesarean section ("section on request"): evidence based or modem vogue?
Grisaru, S; Samueloff, A
Clinics in Perinatology, 31(3): 409-+.
10.1016/j.clp.2004.05.002
CrossRef
Pediatrics
Annual summary of vital statistics: 2004
Hoyert, DL; Mathews, TJ; Menacker, F; Strobino, DM; Guyer, B
Pediatrics, 117(1): 168-183.
10.1542/peds.2005-2587
CrossRef
Clinical and Experimental Allergy
Caesarean delivery and risk of atopy and allergic disesase: meta-analyses
Bager, P; Wohlfahrt, J; Westergaard, T
Clinical and Experimental Allergy, 38(4): 634-642.
10.1111/j.1365-2222.2008.02939.x
CrossRef
Pakistan Journal of Medical Sciences
Magnesium sulphateas a safe treatment for persistent pulmonary hypertension of newborn resistantto mechanical hyperventilation
Dehdashtian, M; Tebatebae, K
Pakistan Journal of Medical Sciences, 23(5): 693-697.

Pelvi-Perineologie
Maternal and foetal's risks of planned and emergency cesarean delivery
Ladaique, A; Leroch', A; Deruelle, P
Pelvi-Perineologie, 4(3): 200-206.
10.1007/s11608-009-0251-z
CrossRef
Birth-Issues in Perinatal Care
Obstetricians' and midwives' attitudes toward cesarean section
Monari, F; Di Mario, S; Facchinetti, F; Basevi, V
Birth-Issues in Perinatal Care, 35(2): 129-135.

Samj South African Medical Journal
First do no harm: Addressing respiratory morbidity in the newborn and child following elective caesarean section before 39 weeks' gestation
Smith, J; Alexander, RJ
Samj South African Medical Journal, 99(): 866-868.

Acta Paediatrica
Neonatal respiratory morbidity risk and mode of delivery at term: influence of timing of elective caesarean delivery
Zanardo, V; Simbi, AK; Franzoi, M; Solda, G; Salvadori, A; Trevisanuto, D
Acta Paediatrica, 93(5): 643-647.
10.1080/08035250410026671
CrossRef
American Journal of Obstetrics and Gynecology
The risks of underwater birth
Pinette, MG; Wax, J; Wilson, E
American Journal of Obstetrics and Gynecology, 190(5): 1211-1215.
10.1016/j.ajog.2003.12.007
CrossRef
Acta Paediatrica
Increasing incidence of respiratory distress in neonates
Ersch, J; Roth-Kleiner, M; Baeckert, P; Bucher, HU
Acta Paediatrica, 96(): 1577-1581.
10.1111/j.1651-2227.2007.00440.x
CrossRef
Clinics in Perinatology
The ethical debate of maternal choice and autonomy in cesarean delivery
Williams, HO
Clinics in Perinatology, 35(2): 455-+.
10.1016/j.clp.2008.03.011
CrossRef
Journal of Perinatal Medicine
Higher risk of persistent pulmonary hypertension of the newborn after cesarean
Jaillard, S; Houfflin-Debarge, V; Storme, L
Journal of Perinatal Medicine, 31(6): 538-539.

Acta Obstetricia Et Gynecologica Scandinavica
Elective caesarean section and respiratory morbidity in the term and near-term neonate
Hansen, AK; Wisborg, K; Uldbjerg, N; Henriksen, TB
Acta Obstetricia Et Gynecologica Scandinavica, 86(4): 389-394.
10.1080/00016340601159256
CrossRef
European Journal of Obstetrics Gynecology and Reproductive Biology
Short-term maternal and neonatal outcomes by mode of delivery - A case-controlled study
Benedetto, C; Marozio, L; Prandi, G; Roccia, A; Blefari, S; Fabris, C
European Journal of Obstetrics Gynecology and Reproductive Biology, 135(1): 35-40.
10.1016/j.ejogrb.2006.10.024
CrossRef
International Journal of Gynecology & Obstetrics
Peripartum hysterectomy in Taiwan
Jou, HJ; Hung, HW; Ling, PY; Chen, SM; Wu, SC
International Journal of Gynecology & Obstetrics, 101(3): 269-272.
10.1016/j.ijgo.2007.12.004
CrossRef
Acta Obstetricia Et Gynecologica Scandinavica
Neonatal respiratory morbidity and mode of delivery in a population-based study of low-risk pregnancies
Farchi, S; Di Lallo, D; Franco, F; Polo, A; Lucchini, R; Calzolari, F; De Curtis, M
Acta Obstetricia Et Gynecologica Scandinavica, 88(6): 729-732.
10.1080/00016340902818154
CrossRef
Jama-Journal of the American Medical Association
Long-term pulmonary consequences of elective cesarean delivery
Karlowicz, AG
Jama-Journal of the American Medical Association, 288(): 1352.

Pediatrics
Survival rates and mode of delivery for vertex preterm neonates according to small- or appropriate-for-gestational-age status
Lee, HC; Gould, JB
Pediatrics, 118(6): E1836-E1844.
10.1542/peds.2006-1327
CrossRef
Journal of Perinatology
Inhaled epinephrine for the treatment of transient tachypnea of the newborn
Kao, B; de Ramirez, SS; Belfort, M; Hansen, A
Journal of Perinatology, 28(3): 205-210.
10.1038/sj.jp.7211917
CrossRef
Clinics in Perinatology
Neonatal morbidity and mortality after elective cesarean delivery
Signore, C; Klebanoff, M
Clinics in Perinatology, 35(2): 361-+.
10.1016/j.clp.2008.03.009
CrossRef
Journal of Perinatal Medicine
To 'C' or not to 'C'? Caesarean delivery upon maternal request: a review of facts, figures and guidelines
D'Souza, R; Arulkumaran, S
Journal of Perinatal Medicine, 41(1): 5-15.
10.1515/jpm-2012-0049
CrossRef
Obstetrics & Gynecology
Elective Primary Cesarean Delivery: Attitudes of Urogynecology and Maternal-Fetal Medicine Specialists
Wu, JM; Hundley, AF; Visco, AG
Obstetrics & Gynecology, 105(2): 301-306.
10.1097/01.AOG.0000151110.05801.c0
PDF (180) | CrossRef
Obstetrics & Gynecology
Singleton Vaginal Breech Delivery at Term: Still a Safe Option
Alarab, M; Regan, C; O'Connell, MP; Keane, DP; O'Herlihy, C; Foley, ME
Obstetrics & Gynecology, 103(3): 407-412.
10.1097/01.AOG.0000113625.29073.4c
PDF (199) | CrossRef
Obstetrics & Gynecology
Late-Preterm Birth: Does the Changing Obstetric Paradigm Alter the Epidemiology of Respiratory Complications?
Yoder, BA; Gordon, MC; Barth, WH
Obstetrics & Gynecology, 111(4): 814-822.
10.1097/AOG.0b013e31816499f4
PDF (285) | CrossRef
Obstetrics & Gynecology
Elective Cesarean Delivery, Neonatal Intensive Care Unit Admission, and Neonatal Respiratory Distress
Yee, W; Amin, H; Wood, S
Obstetrics & Gynecology, 111(4): 823-828.
10.1097/AOG.0b013e31816736e7
PDF (299) | CrossRef
Obstetrics & Gynecology
Interpregnancy Weight Gain and Cesarean Delivery Risk in Women With a History of Gestational Diabetes
Paramsothy, P; Lin, YS; Kernic, MA; Foster-Schubert, KE
Obstetrics & Gynecology, 113(4): 817-823.
10.1097/AOG.0b013e31819b33ac
PDF (204) | CrossRef
Obstetrics & Gynecology
Cesarean Delivery on Maternal Request: Maternal and Neonatal Outcomes
Visco, AG; Viswanathan, M; Lohr, KN; Wechter, ME; Gartlehner, G; Wu, JM; Palmieri, R; Funk, MJ; Lux, L; Swinson, T; Hartmann, K
Obstetrics & Gynecology, 108(6): 1517-1529.
10.1097/01.AOG.0000241092.79282.87
PDF (378) | CrossRef
The Journal of Perinatal & Neonatal Nursing
The Case Against Elective Cesarean Section
Goer, H
The Journal of Perinatal & Neonatal Nursing, 15(3): 23-38.

PDF (73)
MCN: The American Journal of Maternal/Child Nursing
Hypoxia in the Term Newborn: Part Two—Primary Pulmonary Disease, Obstruction, and Extrinsic Compression
Rohan, AJ; Golombek, SG
MCN: The American Journal of Maternal/Child Nursing, 34(3): 144-151.
10.1097/01.NMC.0000351700.12890.da
PDF (4586) | CrossRef
Obstetrical & Gynecological Survey
Patient Choice Cesarean: An Evidence-Based Review
Wax, JR; Cartin, A; Pinette, MG; Blackstone, J
Obstetrical & Gynecological Survey, 59(8): 601-616.

PDF (614)
Back to Top | Article Outline

© 2001 The American College of Obstetricians and Gynecologists

Login

Article Tools

Images

Share