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Association between mode of delivery and neonatal deaths and complications in term pregnancy: a cohort study in Brazil.

AIM
Aim of the study was analyzing the association between mode of delivery and neonatal mortality/ morbidity in term pregnancy.


METHODS
Cohort study with births of liveborn normally formed fetuses from single term pregnancies in a public teaching hospital in São Paulo, Brazil, from January 2003 to March 2004 (total of 1471 births). Data were collected from medical records. We defined 'elective caesareans' as those performed before labor. Four analyses were made: caesarean vs. vaginal, elective vs. non elective caesarean, elective caesarean vs. trial of labor, elective caesarean vs. women in labor. Outcomes studied were: neonatal deaths, jaundice, low Apgar score at 5 minutes, prolonged mechanical ventilation, convulsions, meconium aspiration syndrome, obstetrical trauma and late discharge. Adjustments were made for possible confounders. The chi square test was used along with logistic regression for the analyses. A significance level of 5% was assumed.


RESULTS
A significant negative association between elective caesareans and neonatal death was found, neonatal complications taken as a whole and neonatal complications plus deaths. For example, elective caesarean versus women in labor for the outcome any neonatal complication, adjusted odds ratio 0.59; confidence interval 0.31-0.89.


CONCLUSION
The study highlights a significant negative association of elective caesarean and neonatal mortality and morbidity in term pregnancy.