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OBJECTIVE: To examine the outcomes of neonates born
by elective repeat cesarean delivery compared with vaginal
birth after cesarean (VBAC) in women with one prior
cesarean delivery and to evaluate the cost differences
between elective repeat cesarean and VBAC.
METHODS: We conducted a retrospective cohort study
of 672 women with one prior cesarean delivery and a
singleton pregnancy at or after 37 weeks of gestation.
Women were grouped according to their intention to
have an elective repeat cesarean or a VBAC (successful or
failed). The primary outcome was neonatal intensive care
unit (NICU) admission and measures of respiratory morbidity.
RESULTS: Neonates born by cesarean delivery had
higher NICU admission rates compared with the VBAC
group (9.3% compared with 4.9%, P.025) and higher
rates of oxygen supplementation for delivery room resuscitation
(41.5% compared with 23.2%, P<.01) and
after NICU admission (5.8% compared with 2.4%,
P<.028). Neonates born by VBAC required the least
delivery room resuscitation with oxygen, whereas neonates
delivered after failed VBAC required the greatest
degree of delivery room resuscitation. The costs of elective
repeat cesarean were significantly greater than
VBAC. However, failed VBAC accounted for the most
expensive total birth experience (delivery and NICU use).
CONCLUSION: In comparison with vaginal birth after
cesarean, neonates born after elective repeat cesarean
delivery have significantly higher rates of respiratory
morbidity and NICU-admission and longer length of
hospital stay.
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