Abstract
Background: Cesarean section (CS) is one of the most recurrently carried out surgical procedures in modern obstetrics. Worldwide, about 18.5 million CSs are conducted annually. Of this, 21–33% are performed in middle-and high-income countries. The effectiveness of the CS in preventing maternal and prenatal mortality and morbidity is medically justifiable. However, cesarean delivery without demanding obstetrical indications, by mere maternal request, may expose the child to several risks over benefits. Therefore, we aim to compare spontaneous vaginal delivery (vaginal delivery other than operative vaginal deliveries) and elective CS (CS before the onset of labor, but not including emergency CS) in decreasing the risk of neonatal respiratory morbidity.Objective: To compare the risk of neonatal respiratory morbidity in ECS and spontaneous vaginal delivery.Methods: A literature search was performed through visiting an electronic database (MEDLINE, PubMed, EMBASE, and CINAHL) and gray literature sources, including Google and Google Scholar, from January 2000 to May 2018. Original observational studies that reported the risk of neonatal respiratory morbidity in relation to mode of delivery conducted in the English language were identified and screened. Joanna Briggs Institute's quality assessment tool for observational studies was used to critically appraise the methodological quality of studies. Synthesis of individual studies was conducted using the Review Manager Software version 5.3 for Windows. Heterogeneity among studies was explored using the Cochran's Q-test and the I2 statistics. Pooled effect sizes in relative risk ratios with 95% confidence intervals were calculated. The flow of the study was prepared according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) checklist.Results: Sixteen studies were reviewed. A total of 327,272 neonates born by vaginal delivery and 55,246 born by ECS were included in this study. The risk of neonatal respiratory morbidity was increased by 95% in neonates delivered by ECS (RR = 1.95; 95% CI: 1.40–2.73) as compared with neonates born by spontaneous vaginal delivery.Conclusion: This study investigated the effect of mode of delivery on the respiratory morbidity without considering other risks and found that the ECS has a high risk of developing neonatal respiratory morbidities when compared to spontaneous vaginal delivery. So, we recommend discouraging unnecessary CS.registration: CRD42018104905.
Highlights
Cesarean section (CS) is one of the most recurrently carried out surgical procedures in modern obstetrics
Studies have revealed that the incidence of respiratory morbidity [transient tachypnea neonatal (TTN), respiratory distress syndrome (RDS), or persistence pulmonary hypertension (PPH)] was 10% in neonates born by elective CS (ECS) at 37 weeks as compared to 2.8% among neonates born vaginally [5]
We aim to evaluate the risk of respiratory morbidity in term singleton neonates delivered by ECS vs. spontaneous vaginal delivery (SVD), with ECS considered as an exposure variable, whereas vaginal delivery as the control group; the expected outcomes were neonatal respiratory morbidity and low Apgar score
Summary
Cesarean section (CS) is one of the most recurrently carried out surgical procedures in modern obstetrics. About 18.5 million CSs are conducted yearly worldwide, and 21–33% of all CSs in excess are performed in middle and high-income countries [1, 2]. The effectiveness of CS in preventing maternal and prenatal mortality and morbidity is justifiable medically, though there is no scientific confirmation that shows the benefit of cesarean delivery for the mother or for the newborn baby who does not require CS. CS has short and long-term risks, which may affect the reproductive health and physiological health of the woman and her child. These risks are higher in women with limited access to comprehensive obstetric care [3]. We aim to compare spontaneous vaginal delivery (vaginal delivery other than operative vaginal deliveries) and elective CS (CS before the onset of labor, but not including emergency CS) in decreasing the risk of neonatal respiratory morbidity
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