Korean J Obstet Gynecol.  2011 Jun;54(6):279-285. 10.5468/KJOG.2011.54.6.279.

The pros and cons of different modes of delivery at a single institution

• Ryu JW
• Rho YH
• Han SW
• Ha HY
• Kim EH

• KMID: 2274035
• DOI: http://doi.org/10.5468/KJOG.2011.54.6.279

Abstract

OBJECTIVE
To compare the postpartum maternal and neonatal effects and complications according to delivery modes.
METHODS
Five hundred twenty eight singleton pregnant women, who delivered after 36 gestational weeks in National Health Insurance Corporation Ilsan Hospital between July 2007 and July 2009, were retrospectively analyzed. They were categorized into 3 groups: group A, vaginal delivery; group B, elective cesarean delivery; and group C, emergent cesarean delivery. We evaluated the difference in hemoglobin decrement and postpartum hospital stays, medico-surgical curettage, and antibiotics usage. From the view point of neonates, 1 and 5 minute Apgar scores and Neonatal Intensive Care Unit (NICU) admission rates and meconium aspiration rates were evaluated.
RESULTS
Postpartum hemoglobin decrement and postpartum hospital days were statistically different among the groups, which results were 1.28 vs. 1.88 vs. 2.68 g/dL and 3.5 vs. 5.9 vs. 6.6 days, respectively (p<0.001). Number of out-patient-department follow-up was highest in group C and additional antibiotics usage was highest in group A with statistical significance. The Apgar score was highest in group B (8.0% vs. 3.2% vs. 16.3%, p=0.002). NICU admission rate and meconium aspiration were also lowest in group B (4.5% vs. 0% vs. 7.5%, p=0.001).
CONCLUSION
Although vaginal delivery showed advantage over blood loss related to procedure, hospital days and number of follow up, elective cesarean delivery has advantage carrying less severe complication of mother and better outcome for the baby than other delivery methods.

Keyword

Cesarean section; Delivery, obstetric; Pregnancy complication

MeSH Terms

Anti-Bacterial Agents
Apgar Score
Cesarean Section
Curettage
Delivery, Obstetric
Female
Follow-Up Studies
Hemoglobins
Humans
Imidazoles
Infant, Newborn
Intensive Care, Neonatal
Length of Stay
Lifting
Meconium Aspiration Syndrome
Mothers
National Health Programs
Nitro Compounds
Postpartum Period
Pregnancy
Pregnancy Complications
Pregnant Women
Retrospective Studies
Anti-Bacterial Agents
Hemoglobins
Imidazoles
Nitro Compounds

Figure

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  Fig. 1 Indications of cesarean section. (A) Elective cesarean section. (B) Emergent cesarean section. CDMR, cesarean delivery on maternal request; PIH, pregnancy induced hypertension; CPD, cephalopelvic disproportion.

Reference

1. Health Insurance Review & Assessment Service (HIRAS). Cesarean delivery assement report [Internet]. 2010. cited 2010 Oct 10. Seoul: HIRAS;Available from: http://www.hira.or.kr/common/dummy.jsp.

2. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Cunnigham FG, Leveno KL, Bloom SL, editors. Cesarean delivery and peripartum hysterectomy. Williams obstetrics. 2010. 23rd ed. New York (NY): McGraw-Hill;544–564.

3. Landon MB. Gabbe SG, Niebyl JR, Simpson JL, editors. Cesarean delivery. Obstetrics: normal and problem pregnancies. 2007. 5th ed. Philadelphia (PA): Churchill Livingstone;486–520.

4. Liu S, Liston RM, Joseph KS, Heaman M, Sauve R, Kramer MS. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ. 2007. 176:455–460.

5. Burrows LJ, Meyn LA, Weber AM. Maternal morbidity associated with vaginal versus cesarean delivery. Obstet Gynecol. 2004. 103:907–912.

6. Hall MH, Bewley S. Maternal mortality and mode of delivery. Lancet. 1999. 354:776.

7. Villar J, Carroli G, Zavaleta N, Donner A, Wojdyla D, Faundes A, et al. Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ. 2007. 335:1025.

8. Solheim KN, Esakoff TF, Little SE, Cheng YW, Sparks TN, Caughey AB. The effect of cesarean delivery rates on the future incidence of placenta previa, placenta accreta, and maternal mortality. J Matern Fetal Neonatal Med. 2011 Mar 7 [Epub]. DOI: 10.3109/14767058.2011.553695.

9. Hainer F, Kowalcek I. Vaginal birth versus Cesarean section on demand - which mode of delivery is preferred by pregnant women? Z Geburtshilfe Neonatol. 2011. 215:35–40.

10. Wilson PD, Herbison RM, Herbison GP. Obstetric practice and the prevalence of urinary incontinence three months after delivery. Br J Obstet Gynaecol. 1996. 103:154–161.

11. Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S. Norwegian EPINCONT Study. Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med. 2003. 348:900–907.

12. MacLennan AH, Taylor AW, Wilson DH, Wilson D. The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG. 2000. 107:1460–1470.

13. American College of Obstetricians and Gynecologists. ACOG Committee Opinion. Surgery and patient choice: the ethics of decision making. Obstet Gynecol. 2003. 102:1101–1106.

14. Blomquist JL, Quiroz LH, Macmillan D, McCullough A, Handa VL. Mothers' satisfaction with planned vaginal and planned cesarean birth. Am J Perinatol. 2011. 28:383–388.

15. Abitbol MM, Castillo I, Taylor UB, Rochelson BL, Shmoys S, Monheit AG. Vaginal birth after cesarean section: the patient's point of view. Am Fam Physician. 1993. 47:129–134.

16. Meikle SF, Steiner CA, Zhang J, Lawrence WL. A national estimate of the elective primary cesarean delivery rate. Obstet Gynecol. 2005. 105:751–756.

17. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 394, December 2007. Cesarean delivery on maternal request. Obstet Gynecol. 2007. 110:1501.

18. NIH State-of-the-Science Conference Statement on cesarean delivery on maternal request. NIH Consens State Sci Statements. 2006. 23:1–29.

19. de Almeida MF, Guinsburg R, da Costa JO, Anchieta LM, Freire LM, Campos D Jr. Non-urgent caesarean delivery increases the need for ventilation at birth in term newborn infants. Arch Dis Child Fetal Neonatal Ed. 2010. 95:F326–F330.

20. Quiroz LH, Chang H, Blomquist JL, Okoh YK, Handa VL. Scheduled cesarean delivery: maternal and neonatal risks in primiparous women in a community hospital setting. Am J Perinatol. 2009. 26:271–277.

21. Mutlu B, Aksoy N, Cakir H, Celik H, Erel O. The effects of the mode of delivery on oxidative-antioxidative balance. J Matern Fetal Neonatal Med. 2011.

22. Schulpis KH, Margeli A, Akalestos A, Vlachos GD, Partsinevelos GA, Papastamataki M, et al. Effects of mode of delivery on maternal-neonatal plasma antioxidant status and on protein S100B serum concentrations. Scand J Clin Lab Invest. 2006. 66:733–742.

23. Tateishi H, Yamauchi Y, Yamanouchi I, Khashaba MT. Effect of mode of delivery, parity and umbilical blood gas on first meconium passage in full-term healthy neonates. Biol Neonate. 1994. 66:146–149.

24. Fisler RE, Cohen A, Ringer SA, Lieberman E. Neonatal outcome after trial of labor compared with elective repeat cesarean section. Birth. 2003. 30:83–88.

25. Badawi N, Kurinczuk JJ, Keogh JM, Alessandri LM, O'Sullivan F, Burton PR, et al. Antepartum risk factors for newborn encephalopathy: the Western Australian case-control study. BMJ. 1998. 317:1549–1553.

26. Towner D, Castro MA, Eby-Wilkens E, Gilbert WM. Effect of mode of delivery in nulliparous women on neonatal intracranial injury. N Engl J Med. 1999. 341:1709–1714.

27. Ahmeti F, Azizi I, Hoxha S, Kulik-Rechberger B, Rechberger T. Mode of delivery and mortality among preterm newborns. Ginekol Pol. 2010. 81:203–207.

28. Stuart AE, Matthiesen LS, Källén KB. Association between 5 min Apgar scores and planned mode of delivery in diabetic pregnancies. Acta Obstet Gynecol Scand. 2011. 90:325–331.

29. Smith GC, Pell JP, Cameron AD, Dobbie R. Risk of perinatal death associated with labor after previous cesarean delivery in uncomplicated term pregnancies. JAMA. 2002. 287:2684–2690.