Copyright 2002 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
To the Editor: Dr Smith and colleagues1 concluded that the risk of perinatal death associated with a trial of labor following previous cesarean delivery was significantly higher than that associated with planned repeat cesarean delivery, with an absolute risk increase (ARI) of 0.118% and a number needed to harm (NNH) of 847.
I am concerned that perinatal death was the only neonatal outcome considered. Hook et al2 reported that term neonates who were born by elective repeat cesarean delivery had increased risk of respiratory morbidities compared with those born by trial of labor (ARI, 3%; NNH, 33 for transient tachypnea; ARI, 0.4%; NNH, 250 for respiratory distress syndrome).
Persistent pulmonary hypertension is another serious neonatal morbidity. A case-control study of neonates requiring extracorporeal membrane oxygenation (ECMO)3 reported that 16.5% were term products of elective repeat cesarean deliveries, a significant overrepresentation in the ECMO population (P<.01). In addition, Levine et al4 reported an increased incidence of persistent pulmonary hypertension associated with elective cesarean deliveries compared with vaginal deliveries with an ARI of 0.29% and a NNH of 345. This NNH is less than half the NNH for perinatal deaths after trial of labor reported by Smith et al.
Perhaps, in the study of Smith et al, there was no increase in neonatal deaths after planned repeat cesarean delivery because infants with serious respiratory morbidities survived, thanks to the excellent neonatal intensive care they received. My concern is that in adopting a practice of planned repeat cesarean delivery, the current estimates of NNH suggest that for each prevented perinatal death, there may be risk of 25 cases of transient tachypnea, 3 cases of respiratory distress syndrome, and 2 cases of persistent pulmonary hypertension.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Comments are moderated and will appear on the site at the discretion of the Journal of American Medical Association editors. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Register Now
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.