Morbidity in neonates according to the mode of delivery: a comparative study.

Objective: The objective of this study was to compare the effects of the modes of delivery on the health of newborns in a private maternity hospital in the city of São Paulo.

Methods: Between January 1995 and December 1998, all patients consecutively admitted for deliveries were included in this cross-sectional retrospective study. A total of 8,457 medical records were analyzed, being excluded of the sample 460 multiple pregnancies and 517 pregnant women with obstetric and/or clinical disorders. The incidence of neonatal birth injury, respiratory distress and anoxia was analyzed, as well as birth weight, type of delivery and gestational age (according to Näegele and Capurro).

Results: The final sample consisted of 7,480 neonates, and 69.6% were born by cesarean section, 24% vaginally and 6.4% through the vagina with the aid of forceps. A significant association was found between anoxia and the three types of delivery (p < 0.001). Respiratory distress was more frequent in cesarean delivery in newborns with gestational age superior to 37 weeks and in newborns weighing more than or equal to 2,500 g. Respiratory distress was significantly associated with cesarean delivery and/or forceps delivery, as compared with vaginal delivery, in the entire sample. Neonatal birth injury was associated with the use of forceps. In neonates born by cesarean section, anoxia was associated with lower gestational age estimated by the Capurro method and with lower weight.

Conclusions: The abdominal approach is associated with greater morbidity of fetuses due to respiratory distress. Vaginal delivery is safer in newborns with more than 37 weeks of gestation and in those weighing more than 2,500 g.