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Lydon-Rochelle, M., et al. Risk of uterine rupture during labor among women with a prior cesarean delivery. N Engl J Med 2001;345(1):3-8.
Study design and results: evaluation of 20,095 Washington State women having a second child after having the first by cesarean section.
Chances of the scar giving way (uterine rupture):
elective cesarean section: 1.6 per 1,000
spontaneous labor onset: 5.2 per 1,000
induced labor, no prostaglandin: 7.7 per 1,000
induced labor with prostaglandin: 24.5 per 1,000
Chances of hysterectomy or infant death: (Note: The investigators did not report these outcomes. They were calculated from study data.)
elective cesarean section: hysterectomy 1 per 10,000; infant death 1 per 10,000
spontaneous labor onset: hysterectomy 2 per 10,000; infant death 3 per 10,000
induced labor, no prostaglandin: hysterectomy 3 per 10,000; infant death 4 per 10,000
induced labor with prostaglandin: hysterectomy 11 per 10,000, infant death 13 per 10,000[/b]
Investigators evaluate the relationship between gestational age at elective cesarean delivery and neonatal intensive care unit admission and respiratory distress.
MedWire News: Researchers recommend delaying elective cesarean delivery beyond 37 weeks' gestation, if possible, to reduce the risk for admission to neonatal intensive care units (NICU) and respiratory distress.
"In our population if elective cesarean delivery were planned for beyond 270 days (38 weeks) of gestation, the risk of respiratory distress could be reduced by 50 percent and NICU admission by approximately 40 percent in these neonates," report Wendy Yee and colleagues from the University of Calgary in Alberta, Canada.
The researchers reviewed the medical charts of 1,193 mother-infant pairs. Infants born at 36 weeks or more and weighing 2,500 g or more were included.
Overall, 13.1 percent of infants delivered by elective cesarean were admitted to NICU, compared with 7.3 percent of all infants delivered vaginally in the preceding year.
About 10 percent of infants admitted to the NICU had respiratory distress. The team's analysis indicated that a 1-day advancement in gestational age could reduce the risk for respiratory distress by 7 percent.
Yee et al note that waiting for delivery symptomatic contractions or ruptured membranes before carrying out cesarean delivery did not offer any additional protection against NICU admission or respiratory distress.