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C
esarean
on
request
R
ev
A
ssoc
M
ed
B
ras
2015; 61(4):296-307
301
Effect of cesarean section on maternal request or without indi-
cation on respiratory complications
Four studies (
B
)
3-5,8
assessed the respiratory complications
of the newborn related to cesarean delivery on maternal
request or without indication. The average obtained from
all studies demonstrate that respiratory complications in
the cesarean group total 3.1
versus
5.7% in the group of
planned vaginal delivery (Table 6). However, the meta-anal-
ysis shows that the cesarean delivery on maternal request
is associated with a significant increase of 1.0% (95CI: 0.01
to 0.02; p<0.00001; I
2
=96%; Figure 3.3) in the absolute risk
of the development of respiratory complications.
Effect of cesarean section on maternal request or without indi-
cation on the rate of newborn infection
The average of infectious complications (
B
)
3-5
in the group
of cesarean delivery on maternal request is 0.4%, while in
the group of planned vaginal delivery the rate of infection
is 0.3% (Table 6). Although there are differences in favor of
cesarean delivery, the meta-analysis shows no significant
TABLE 6
Newborn complications.
C-section without indication
n
Vaginal delivery n
p
Average birth weight (SD)
Karlström 2013 3558 (±448)
5877
3665 (±467)
12936
<0,0000001
Crowther 2012 3462 (±451)
1098
3571 (±495)
1225
<0,0000001
Liu 2012
3438 (±393)
22462
3332 (±375)
409242
<0.0000001
Larsson 2011 3339
247
3617
294
<0,001
Dahlgren 2009 3383.8 (±415.96)
1046
3531.4 (±441.85) 38021
<0,0000001
C-section without medical
indication
n RA
PC
Vaginal delivery n
RA
PV
RRA (-)
ARA (+)
CI
Apgar score ≤ 7 (%)
Karlström 2013 38 (0.6)
5877 0.65% 252 (1.8)
13774 1.83% -1.18%
-1.48, -0.88
Crowther 2012 0 (0.0)
1098 0.0 1 (0.1)
1225 0.08% -0.08% -0.24, 0.08
Larsson 2011
Average
-
Average
-
Dahlgren 2009 0 (0.0)
1046 0.0 182 (0.48)
38021 0.48% -0.48%
-0.55, -0.41
Respiratory complications (%)
Karlström 2013 159
5877 2.7% 153
13774 1.11% 1.59%
1.14, 2.04
Crowther 2012 2
1098 0.18% 1 (0.1)
1225 0.08% 0.10% -0.20, 0.40
Dahlgren 2009 91
1046 8.7% 2900 (7.63)
38021 7.63% 1.07% -0.65, 2.80
Schindl 2003 1
147 0.68% 0 (0.0)
903 0.0
0.68% -0.65, 2.01
Asphyxia (%)
Karlström 2013 3 (0.1)
5877 0.05% 78 (0.5)
13774 0.56% -0.51%
-0.65, -0.38
Crowther 2012 1 (0.1)
1098 0.09% 6 (0.5)
1225 0.49% -0.40% -0.83, 0.03
Dahlgren 2009 1 (0.1)
1046 0.10% 51 (0.13)
38021 0.13% -0.04% -0.23, 0.15
Infection (%)
Karlström 2013 29 (0.5)
5877 0.11% 111 (0.8)
13774 0.0% 0.11% -0.11, 0.33
Crowther 2012 1 (0.1)
1098 0.09% 4 (0.3)
1225 0.33% -0.23% -0.60, 0.13
Dahlgren 2009 1 (0.1)
1046 0.09% 29 (0.08)
38021 0.08% 0.02% -0.17, 0.21
Admission to neonatal ICU (%)
Crowther 2012 4 (0.4)
1098 0.36% 7 (0.6)
1225 0.57% -0.21% -0.76, 0.34
Larsson 2011 13 (5.3)
247 5.26% 15 (5.1)
294 5.10% 0.16% -3.59, 3.91
Souza 2010
33 (1.2)
2685 1.23% 4532 (1.8)
256869 1.76% -0.53%
-0.95, -0.11
Wiklund 2007 5
99 5.05% 12
237 5.06% -0.01% -5.15, 5.12
Schindl 2003
0 (0.0)
147 0.0 1 (0.1)
903 0.11% -0.11% -0.33, 0.11
P values < 0.05 and confidence intervals that exclude null values are in bold.