Delivery After Previous Cesarean: Long-Term Outcomes in the Child

• Published in: Seminars in perinatology Vol. 34; no. 4; pp. 281 - 292
• Main Authors: O'Shea, T. Michael, MD, MPH, Klebanoff, Mark A., MD, MPH, Signore, Caroline, MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2010
• Subjects: asthma; Asthma - epidemiology; brachial plexus injury; Brachial Plexus Neuropathies - epidemiology; Brain Diseases - epidemiology; cesarean delivery; Cesarean Section, Repeat - adverse effects; Dystocia; Female; Gestational Age; Humans; Hypoxia-Ischemia, Brain - epidemiology; Infant, Newborn; Neonatal and Perinatal Medicine; neonatal encephalopathy; Nervous System Diseases - epidemiology; Pregnancy; Pregnancy Outcome - epidemiology; Respiratory Distress Syndrome, Newborn - epidemiology; Risk Factors; Shoulder; shoulder dystocia; Trial of Labor; Uterine Rupture; Vaginal Birth after Cesarean - adverse effects; vaginal delivery; neonatal encephalopathy; shoulder dystocia; uterine rupture; asthma; brachial plexus injury; cesarean delivery; vaginal delivery
• ISSN: 0146-0005; 1558-075X
• DOI: 10.1053/j.semperi.2010.03.008

In subsequent pregnancies after a cesarean delivery, women must choose between attempting to deliver vaginally or undergoing another cesarean delivery. Information relevant to this choice includes the long-term benefits and harms to the baby. In this article we discuss the relationship of mode of delivery (planned trial of labor, either with or without vaginal delivery, or elective repeat cesarean delivery) and long-term outcomes, including brachial plexus palsy, neurodevelopmental impairment, and asthma. No randomized trials are available that relate directly to the choice of delivery method after previous cesarean. Observational studies suggest that cesarean delivery might be associated with a greater risk of asthma, caused perhaps by altered gut colonization, increased risk of neonatal respiratory disease, decreased gestational age at birth or decreased likelihood of breastfeeding. By contrast, vaginal delivery after a previous cesarean delivery is associated with greater risks of neurodevelopmental impairment and upper-extremity motor impairment, caused, respectively, by greater risks of perinatal hypoxic-ischemic encephalopathy and brachial plexus injury. Available information does not provide a precise estimate of the relative risks for infants delivered after a trial of labor versus elective cesarean delivery.