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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 . . . [Full Text of this Article]

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RELATED ARTICLE

Risk of Perinatal Death Associated With Labor After Previous Cesarean Delivery in Uncomplicated Term Pregnancies
Gordon C. S. Smith, Jill P. Pell, Alan D. Cameron, and Richard Dobbie
JAMA. 2002;287(20):2684-2690.
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