New York Study Regarding Information on Birth Defects
The rate of infection is lower for all vaginal deliveries than for all cesarean deliveries. Planned cesarean deliveries have lower infection rates than unplanned cesarean deliveries but higher rates than vaginal deliveries. Conflicting studies generally show a lower rate of anesthetic complications with planned vaginal delivery than with planned cesarean delivery. However, the surveyed literature has a higher prevalence of general anesthesia and a decreased utilization of regional anesthesia for unscheduled cesarean deliveries than in contemporary practice, which may mitigate the possible advantage for planned vaginal delivery. A potential advantage of planned cesarean delivery is the avoidance of emergency induction of anesthesia. While in-hospital post-cesarean analgesia practices have improved markedly, less attention has been focused on quantitation and management of perineal pain. Reliable information is lacking regarding short term post-discharge pain.
The risk of this complication increases with the number of prior cesarean deliveries, advancing maternal age, and parity. A meta-analysis indicates a doubling of risk in women who have had cesarean deliveries compared to women who have had vaginal deliveries. Studies indicate that the rate of stress urinary incontinence (SUI) after elective cesarean delivery is lower than for vaginal delivery, but the duration of this effect is not clear, particularly in older populations and in women who had multiple deliveries. There is evidence that the risk of SUI may be increased when forceps are used to assist vaginal delivery. Urinary incontinence is multifactorial, and reduction in SUI associated with cesarean delivery on maternal request may be partially offset by other processes including advancing age and increases in body-mass index (BMI). Uterine rupture is a concern in subsequent pregnancies. Meta-analyses provide consistent evidence that the incidence of uterine rupture during attempted VBAC is significantly higher than with elective repeat cesarean delivery.
Existing evidence from weak-quality studies has shown no difference in the risk of peripartal hysterectomy among those with first planned vaginal delivery or planned cesarean delivery, although these studies generally lacked adequate power to examine these outcomes. However, there is convincing evidence of increased risk of hemorrhage and hysterectomy in patients with multiple cesarean deliveries; decisions regarding route of delivery should be influenced by the number of pregnancies expected or planned. The risk of hysterectomy for placenta previa and placenta accreta increases sharply with increasing numbers of cesarean deliveries. For the women with one prior cesarean delivery, a decision-analysis indicated that cesarean delivery likely will result in fewer hysterectomies because of the decreased incidence of uterine rupture. However, in women with multiple cesarean deliveries, the likelihood of hysterectomy is elevated because of the increased frequency of placenta accreta. Based on epidemiologic modeling, there is an increased risk of stillbirth in the planned vaginal delivery group, because planned cesarean delivery would result in delivery by 40 weeks of gestation, and planned vaginal delivery could occur up to 42 weeks of gestation.
