Marja Kupari1, Nina Talola2, Tiina Luukkaala2,3, Kati Tihtonen4. 1. School of Medicine, University of Tampere, Tampere, Finland. 2. School of Health Sciences, University of Tampere, Tampere, Finland. 3. Science Center, Pirkanmaa Hospital District, Tampere, Finland. 4. Department of Obstetrics and Gynecology, Tampere University Hospital, PL 2000, 33521, Tampere, Finland. kati.tihtonen@pshp.fi.
Abstract
PURPOSE: To clarify whether an increased cesarean section rate improves the short-term neonatal outcome in singleton term pregnancies with cephalic presentation. METHODS: A retrospective study of institutional data on the mode of delivery and neonatal outcome. The study included two cohorts: 1998-1999 (n = 7437) and 2004-2005 (n = 8505), since the institutional cesarean section rate increased sharply between these cohorts and has remained stable after the latter study period. RESULTS: The caesarean section rate almost doubled from 6.8 to 11.3 % (p < 0.001), during the study period. The rate of neonates suffering severe birth asphyxia remained low in both cohorts (0.4 vs. 0.6 %) and there were no significant differences in neonatal outcome (Apgar score <4 at 1 min and Apgar score <7 at 5 min, severe birth asphyxia, resuscitation or artificial ventilation) between the study periods. In the subgroup of neonates delivered vaginally, no significant differences were found in the above-mentioned neonatal outcomes between the cohorts. Apart from other outcomes admissions to neonatal intensive care unit increased significantly (p < 0.001) during the latter period (0.8 vs 1.6 %). CONCLUSIONS: Increasing cesarean section rate from a low to a moderate does not improve the short-term neonatal outcome in term singleton pregnancies. On the contrary neonatal intensive care unit admissions increased with increasing caesarean section rate. Furthermore it is possible to achieve good neonatal outcome with a low cesarean section rate.
PURPOSE: To clarify whether an increased cesarean section rate improves the short-term neonatal outcome in singleton term pregnancies with cephalic presentation. METHODS: A retrospective study of institutional data on the mode of delivery and neonatal outcome. The study included two cohorts: 1998-1999 (n = 7437) and 2004-2005 (n = 8505), since the institutional cesarean section rate increased sharply between these cohorts and has remained stable after the latter study period. RESULTS: The caesarean section rate almost doubled from 6.8 to 11.3 % (p < 0.001), during the study period. The rate of neonates suffering severe birth asphyxia remained low in both cohorts (0.4 vs. 0.6 %) and there were no significant differences in neonatal outcome (Apgar score <4 at 1 min and Apgar score <7 at 5 min, severe birth asphyxia, resuscitation or artificial ventilation) between the study periods. In the subgroup of neonates delivered vaginally, no significant differences were found in the above-mentioned neonatal outcomes between the cohorts. Apart from other outcomes admissions to neonatal intensive care unit increased significantly (p < 0.001) during the latter period (0.8 vs 1.6 %). CONCLUSIONS: Increasing cesarean section rate from a low to a moderate does not improve the short-term neonatal outcome in term singleton pregnancies. On the contrary neonatal intensive care unit admissions increased with increasing caesarean section rate. Furthermore it is possible to achieve good neonatal outcome with a low cesarean section rate.
Authors: Anna E Seijmonsbergen-Schermers; Thomas van den Akker; Eva Rydahl; Katrien Beeckman; Annick Bogaerts; Lorena Binfa; Lucy Frith; Mechthild M Gross; Björn Misselwitz; Berglind Hálfdánsdóttir; Deirdre Daly; Paul Corcoran; Jean Calleja-Agius; Neville Calleja; Miriam Gatt; Anne Britt Vika Nilsen; Eugene Declercq; Mika Gissler; Anna Heino; Helena Lindgren; Ank de Jonge Journal: PLoS Med Date: 2020-05-22 Impact factor: 11.069