Perinatal impact of cesarean delivery on maternal request compared with vaginal delivery among low-risk pregnancies in a University Hospital: A prospective observational study in Bogotá, Colombia

Abstract

Objective: There is insufficient evidence about the impact of cesarean delivery on maternal request (CDMR). This study was designed to evaluate different maternal and neonatal outcomes comparing CDMR with vaginal deliveries in lowrisk pregnancies. Materials and methods: Prospective observational study including women aged 18 to 45 with a low-risk, term pregnancy, who delivered between June 2008 and April 2012 at a University Hospital in Bogota Colombia. The occurrence of any of 5 pre-specified adverse maternal events (maternal outcome) and of any of 17 pre-specified adverse neonatal events (neonatal outcome) was compared between CDMR and vaginal deliveries. Induced vaginal deliveries were analyzed separately. All women received the same standard of care. The effect of confounders was adjusted using multivariate logistic regression. Results: The study included 214 women with CDMR, 341 with spontaneous vaginal delivery (SVD) and 376 with induced vaginal delivery (IVD). Relative to the SVD group, the multivariateadjusted odds ratios for adverse maternal outcomes were 0.21 (95% CI: 0.05-0.97) in the CDMR group and 0.93 (95% CI: 0.42-2.06) in the IVD group. The multivariate ORs for adverse neonatal outcomes were 0.59 (95% CI: 0.36-0.93) for CDMR and 0.84 (95% CI: 0.59-1.21) for IVD. The frequency of hospitalization of the newborn was lowest in the cesarean delivery group (10.3% versus 15.8% for spontaneous deliveries, 16.2% for induced vaginal deliveries). Conclusions: Among low-risk pregnancy women who entered a standardized obstetric care protocol, CDMR was associated with a lower rate of adverse perinatal outcomes when compared to spontaneous vaginal delivery. Further studies are needed to assess long-term the safety of CDMR.