Neonatal outcomes associated with planned vaginal versus planned primary cesarean delivery.

OBJECTIVE

To determine whether planned route of delivery leads to differences in neonatal morbidity.

STUDY

DESIGN

Analysis was based on planned route of delivery, not actual route of delivery. A total of 4048 subjects were divided into two groups: planned vaginal delivery and planned cesarean delivery. Primary outcomes were neonatal intensive care unit (NICU) admission, respiratory morbidity and neurologic morbidity.

RESULT: There were 3868 planned vaginal and 180 planned cesarean deliveries. Planned vaginal delivery had decreased NICU admission (P<0.0001), oxygen resuscitation (P=0.001) and jaundice (P<0.0001) but increased meconium passage (P<0.0001) and 1 min Apgar <or=5 (P=0.02). After multivariable regression, NICU admission remained lower and meconium passage remained higher in the planned vaginal group.

CONCLUSION

Planned vaginal delivery led to more meconium passage and low 1 min Apgar but less NICU admissions, oxygen resuscitation and jaundice. Multicenter trials are needed to assess rare but serious outcomes based on planned route of delivery.