Planned c-sections not for preterm pregnancies

New research suggests that elective c-sections should not be performed in pregnant women until they have reached full term. Performing the operation too early in pregnancy increases the risk of complications and even death for the new born, according to a report in the journal Pediatrics.

“A cesarean section can save the life of the mother and child, but this does not mean that it is safer than vaginal delivery and even attempted vaginal delivery,” Dr. Riccardo Erennio Pfister from University Hospital of Geneva, Switzerland told Reuters Health. “Vaginal delivery is a desirable event” for the newborn, he added.

Pfister and colleagues investigated newborn complications associated with elective c-section and planned vaginal delivery in nearly 60,000 late-preterm and term infants.

Neonatal death rates were 0.57 percent after elective c-section and 0.10 percent after planned vaginal delivery, the authors report.

Compared with planned vaginal delivery, elective c-section was associated with increased death rates in the full-term group but not in the late-preterm group, the authors report. They add that mortality rates after elective c-section were similar to rates after emergency c-section.

Depression at birth was slightly less frequent after elective c-section in the term group, but more frequent after elective c-section in the late-preterm group, compared to the planned vaginal delivery group.

Special care admissions were more frequent after elective c-section than after planned vaginal delivery, with “the risk of admission decreasing with increasing gestational age,” the researchers said.

Breathing complications were twice as common after elective c-section than after planned vaginal delivery, in both the term babies and late-preterm babies.

Pfister maintains that elective caesarian delivery “should be reserved for conditions that have been tested by (studies) to reduce a specific risk,” such a breech presentation at term. He points out, however, that “the maternal/neonatal outcomes depend on the level of care of this intervention and may not be automatically applied to any facility or country.”

“As elective cesarean is convenient for the medical team and patient in different terms (agenda, workload, financial) and furthermore protects the medical team from legal suits arising from pregnancy complications…there is little incentive to favor vaginal delivery,” Pfister continued. “Medical teams need objective data and legal protection from governments based on such data to support vaginal delivery and reduce elective cesarean (delivery).”

SOURCE: Pediatrics, June 2009.

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