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Cesarean May Not Save Premature Babies

By jeremyc | February 13, 2012

A recent study on cesarean deliveries found that C-sections failed to reduce the risk of neonatal complications that arise in premature babies. On the contrary, a cesarean delivery increased the risk of respiratory distress in premature babies suffering from intra-uterine growth restrictions as compared to a normal vaginal delivery. This study was conducted by Dr. Erika F. Werner, M.D., and other colleagues at the Johns Hopkins University. The results of this study were revealed at the recently held annual meeting of the Society for Maternal-Fetal Medicine.

During the presentation of these results in the meeting, Dr. Werner said, “The highest rate [of cesarean deliveries] is seen among neonates delivered prior to 24 weeks. In 2005, more than 50% of these babies were born by cesarean delivery.” Despite the lack of studies conducted in this regard, a C-section was suggested as a possible way to increase the chances of survival and lower the risk of neonatal morbidity among growth-restricted babies.

The few studies that provided an insight into the outcomes of delivery have had conflicting results. While some studies find no difference in risks involved in a vaginal and cesarean delivery of a baby weighing less than 1.5 kg, other studies found that a vaginal delivery increased the risk of intra-ventricular hemorrhage and mortality in such infants. With such varying results for the same subject, Dr. Werner felt that there was a need to reexamine the relation between the delivery route and neonatal risks involved.

The study conducted by Werner and colleagues involved the analysis of discharge data from New York City hospitals between 1995 and 2003. During this time period, more than a million babies were born, out of which 2,885 were small for their respective gestational age, which is a substitute for intra-uterine growth restriction, and were born premature between 25 and 34 weeks of pregnancy.

Of these 2,885 infants, approximately 58% were born by C-section delivery, and the remaining infants had a vaginal delivery. The cesarean section option was found to be more common among educated, white and older mothers and those who had a private insurance plan. Most of these C-section deliveries had a 5-minute Apgar score of less than 7 (unadjusted). However, the difference between C-section and vaginal delivery disappeared when the score was adjusted for ethnicity, gestational age at delivery and maternal age.

Further tests showed that other than respiratory distress, there were no adjusted problems that were more or less likely to occur in either delivery route. This included seizures, subdural hemorrhage, intra-ventricular hemorrhage and sepsis.

In other words, a cesarean section did not really lower the risks of neonatal complications. On the contrary, it increased the risk of respiratory problems. This raises questions about the safety and benefits of a cesarean delivery for high-risk neonates. It must be noted that the study conducted by Werner and other Johns Hopkins University colleagues has been published as an abstract. Its conclusions, while eye-opening, are to be considered preliminary until it is published in a peer-reviewed journal.

Topics: | Women's Health |

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