[Benefits and harms to the newborn of maternal attempt at trial of labor after prior caesarean versus elective repeat caesarean delivery]

Abstract

Objective: To evaluate neonatal outcome after elective repeat cesarean delivery (ERCD) versus trial of labor (TOL) after previous cesarean delivery.

Methods: This systematic evidence review is based on Pubmed search, Cochrane library and experts recommendations.

Results: The risks of fetal, perinatal and neonatal mortality are low after previous cesarean delivery but significantly higher for TOL as compared with ERCD. The risk of bag-and-mask ventilation and intubation for meconium-stained amniotic fluid are higher for TOL as compared with ERCD. Infants born after ERCD are more likely presented transient tachypnea. The risk of hypoxic encephalopathy/asphyxia is low after previous cesarean delivery but significantly higher for TOL as compared with ERCD. The risk of neonatal sepsis after previous cesarean delivery is significantly higher for TOL as compared with ERCD. There is no significant difference between TOL or ERCD regarding NICU admission. The strength of evidence is low to conclude about the impact of route of delivery upon birth trauma and Apgar score.

Conclusions: The risk of the main neonatal complications is low whatever the route of delivery after previous caesarean delivery. However, the risk of perinatal mortality, bag-and-mask ventilation, perinatal asphyxia, is higher after TOL compared with ERCD. The risk of transient tachypnea is higher after ERCD compared with TOL.