Planned primary c-section risky in low-risk women: study was in primiparous women at term.(NEWS)

SAN DIEGO -- Planned primary cesarean delivery was associated with increased morbidity and mortality compared with vaginal delivery, among low-risk primiparous women at term, results from a large population-based study showed.

Clinicians have debated the role of planned primary cesarean delivery over the last decade in particular, yet "there is little evidence to help guide us in how to counsel patients on the risks and benefits" of the procedure, Dr. Lisa May Olson said at the annual meeting of the Society for Maternal-Fetal Medicine.

Dr. Olson, a recent graduate of the MD/MPH program at Oregon Health and Science University, Portland, noted that the rate of planned primary cesarean delivery in the United States has been increasing in the last decade, with a high of 20% in 2006, up from 17% in 2002.

A study from 2007 found that about 36% of elective repeat cesarean deliveries are performed before 39 weeks, and that these early births carry an increased risk of adverse neonatal outcomes (N. Engl. J. Med. 2009; 360:1-20).

Using administrative discharge data for low-risk primiparous women who gave birth to a term singleton infant in California hospitals during 2002, Dr. Olson and her associates compared maternal and neonatal outcomes of planned primary cesarean, with and without labor, to maternal and neonatal outcomes of vaginal delivery. The data, obtained from the California Office of Statewide Health Planning and Development, linked mother and neonatal hospital discharge and vital statistics data.

Specific maternal outcomes studied included hemorrhage, the need for transfusion, uterine rupture, emergent hysterectomy, cardiac complications, major infection, pulmonary embolism, shock, and death.

Specific neonatal outcomes studied included transient tachypnea of the newborn (TTN), respiratory distress syndrome, neonatal intensive care unit admission, sepsis, intracranial ...