Effect of prior cesarean delivery on neonatal outcomes

Abstract

Aims: To examine the effect of a prior cesarean delivery on neonatal outcomes.

Methods: We conducted a retrospective cohort study on all women with a prior livebirth who delivered at the Royal Victoria Hospital between 2001 and 2006. We defined our exposure as a positive history for cesarean delivery and used unconditional logistic regression analysis to estimate the adjusted effect of a previous cesarean delivery on adverse neonatal outcomes.

Results: A total of 18,673 births took place of which 9708 were in women with a prior livebirth (77.0% with no previous cesarean delivery and 23.0% with a previous cesarean delivery). As compared to newborns delivered by mothers with no prior cesarean delivery, increasing number of prior cesarean deliveries was associated with an increasing risk of preterm birth [odds ratio (OR) 1.23, 95% confidence interval (CI) 1.09–1.39]; respiratory distress syndrome (OR 3.54, 95% CI 2.02–5.91); and admission to the neonatal intensive care unit (OR 1.41, 95% CI 1.25–1.60). These findings were predominantly due to differences in gestational age and mode of delivery.

Conclusion: Having a prior cesarean delivery is associated with an increased risk of adverse neonatal outcomes. Adverse neonatal outcomes in subsequent pregnancies is additional evidence to suggest that unless specifically indicated, cesarean delivery should be avoided.