Second Cesarean Safer Than Normal Delivery

New research has found that a woman who has already had one cesarean section will fare better, as will her baby, with a second cesarean than with a vaginal delivery. The finding was reported in the December 16, 2004, issue of The New England Journal of Medicine. Lead author was Mark B. Landon, M.D., of Ohio State University (Columbus, USA).

The study involved nearly 46,000 women at 19 academic health centers belonging to the Maternal-Fetal Medicine Units Network of the U.S. National Institute of Child Health and Human Development (NICHHD). The issue is important because of the current over-use of cesarean sections, which reached 26% of all births in 2002.

"This study shows the risk of adverse perinatal outcomes is increased with a trial of labor after a prior cesarean delivery but also confirms that the risk is still very small,” reported Margaret A. Harper, M.D., professor of obstetrics and gynecology at Wake Forest Baptist Medical Center (Winston-Salem, NC, USA) and one of the researchers.

In the study, the rate of uterine rupture was seven per 1,000 among the mothers who were attempting vaginal delivery, compared to no ruptures among the women who chose a second cesarean. Endometritis developed in 2.9% of the women who chose normal delivery, compared to 1.8% of those electing a second cesarean. Also, among the women who elected normal delivery, 1.7% required a transfusion, compared to only 1% in the cesarean group. In about one in 2,000 cases, the baby was affected adversely during or after the attempt at normal delivery. The risk is quantitatively small but still greater than the risk associated with elective repeated cesarean delivery.

In addition, insufficient oxygen supply to the brain, which can lead to acute brain injury, was shown to be significantly greater among babies of women who had a normal delivery, eight per 10,000, with no cases at all in the cesarean group. On the other hand, if a number of future pregnancies are planned, a woman must realize that the risks of complications increase as the number of cesareans increases.




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Wake Forest Baptist Medical Center