1. Asthma at 8 years of age in children born by cesarean section. (Roduit, et at., Thorax. Epub, 3 December)
Study Design: Researchers assessed the relationship between childhood respiratory disease and cesarean section. Bottom Line: Children born by cesarean section to non-allergic parents have a 2.14 times higher risk of asthma than those born by vaginal delivery.

      2. Cesarean birth in the United States: epidemiology, trends and outcomes. (MacDorman, et al., HYPERLINK "javascript:AL_get(this,%20'jour',%20'Clin%20Perinatol.');" Clin Perinatol. 35(2):293-307, June) Study Design: Researchers analyzed data describing cesarean births. Bottom Line: Both primary and repeat cesareans have increased. Increases in non-medically indicated primary cesareans have been more rapid than in the overall population and seem the result of changes in obstetric practice rather than changes in the medical risk profile or increases in "maternal request."

      3. Increased risk of stroke in patients who undergo cesarean section delivery: a nationwide population-based study. (Lin, et al., Am J Obstet Gynecol. 198(4):391.e1-7, 14 Feb)
Study Design: Researchers examined population data to determine if cesarean sections increase the risk of stroke.
Bottom Line: At 3, 6, and 12 months after delivery, rates of stroke among the mothers were 67 percent, 61 percent, and 49 percent higher, respectively, following cesarean rather than vaginal birth. Cesarean section delivery is an independent risk factor for stroke.

4. Safety and efficacy of external cephalic version for women with a previous cesarean delivery. (Sela, et al., Eur J Obstet Gynecol Reprod Biol, Epub, 17 November)
Study Design: Researchers evaluated the success and complications after external cephalic version for breech position in women with one previous cesarean. Bottom Line: The success rate was 74%, and 84% of women with successful versions delivered vaginally. There were no negative outcomes for any of the women or babies. Women with a breech baby and a previous cesarean should be informed about the success and safety of this procedure.

5. Perinatal outcomes in the setting of active phase arrest of labor. (Henry, et al., Obstet Gynecol. 112 (5):1109-15, November)
Study Design: Researchers compared outcomes of cesarean delivery vs. vaginal delivery in women with stalled labor. Bottom Line: Cesarean delivery was associated with an increased risk of chorioamnionitis, endomyometritis, postpartum hemorrhage , and severe postpartum hemorrhage. There were no differences in complications with babies. Among women who delivered vaginally, women with a stalled labor had significantly increased odds of chorioamnionitis and shoulder dystocia. However, there were no differences in the serious problems associated with these outcomes. Efforts to achieve vaginal delivery in the setting of active phase arrest may reduce the maternal risks associated with cesarean delivery without additional risk to the baby.

6. Physician financial incentives and cesarean delivery: New conclusions from the healthcare cost and utilization project. (Grant, J Heath Econ. Epub 2 October)
Study Design: Researcher analyzed the relationship between physician fees and the number of cesareans performed. Bottom Line: Analysis indicates that an increase of $1000 in the reimbursement for a cesarean section increases the rate of cesarean delivery by about 1%.

7. Can a prediction model for vaginal birth after cesarean also predict the probability fo morbidity related to a trial of labor? (Grobman, et al., Am J Obstet Gynecol Epub 24 2008)
Study Design: Researchers determined whether predicting the likelihood of a VBAC was effective in predicting the likelihood of morbidity associated with a trial of labor. Bottom Line: If the chance of a successful VBAC is estimated at 70% or better, then the likelihood of complications in the mother is the same as with an elective repeat cesarean. The results were the same for the likelihood of complications in the baby as well.

8. Maternal morbidity following a trial of labor after cesarean section vs elective repeat cesarean delivery: a systematic review with metaanalysis. (Rossi, Am J Obstet Bynecol. 199(3):224-31, September)
Study Design: Researchers reviewed maternal complications following trial of labor after cesarean section, compared with elective repeat cesarean delivery. Bottom Line: VBAC was successful 73% of the time. Maternal morbidity, blood transfusion, and hysterectomy were similar in women planning VBAC or repeat cesarean. Maternal morbidity, uterine rupture/dehiscence, blood transfusion and hysterectomy were more common after a failed trial of labor than after a successful VBAC or repeat cesarean but outcomes were more favorable after a successful VBAC than repeat cesarean. These findings show that a higher risk of uterine rupture/dehiscence in women planning VBAC is counterbalanced by a reduction of maternal morbidity, uterine rupture/dehiscence and hysterectomy when VBAC is successful.

9. Suspected macrosomia? Better not tell. (Sadeh-Mestechkin, et al., Arch Gynecol Obstet. 287(3):225-30, September)
Study Design: Researchers reviewed records of women with suspected macrosomia compared to all women who gave birth during the same time frame. Bottom Line: Induction of labor and cesarean delivery rates in the macrosomic pregnancies (actual birth weight >4,000 g) of the study group were significantly higher than the macrosomic pregnancies in the comparison group. No significant difference was seen in maternal or infant complications when comparing non-macrosomic pregnancies to macrosomic pregnancies in the suspected macrosomia group. The ability to predict macrosomia is poor. The management policy of suspected macrosomic pregnancies raises induction of labor and cesarean delivery rates without improving maternal or fetal outcome.

10. Placenta accreta and cesarean scar pregnancy: overlooked costs of the rising cesarean section rate. (Rosen, Clin Perinatol. 35(3):519-29, September)
Study Design: Author reviewed theories on abnormal placentation. Bottom Line: The rising cesarean rate has resulted in an increase in placenta accreta and cesarean scar pregnancy which are associated with high rates of maternal morbidity and mortality. Improvements in management and future research to reduce the incidence of the potentially devastating complication are necessary.

11. Vaginal birth after cesarean delivery. (Landon, Clin Perinatol. 35(3):491-504, September)
Study Design: Author reviewed incidence of and complications associated with VBAC. Bottom Line: By 2004, only 9.2% of women in the United States with prior cesareans underwent a trial of labor, although nearly two thirds of these women were candidates for a trial of labor. Women with prior cesarean deliveries are at risk for maternal and perinatal complications, whether undergoing a trial of labor or choosing elective repeat cesarean section. Complications of both procedures should be discussed and an attempt made to individualize the risks of repeat cesarean and the likelihood of successful VBAC for each woman.

12. Cesarean delivery may affect the early biodiversity of intestinal bacteria. (Biasucci, J Nutr. 138(9):1796S-1800S, September)
Study Design: Researchers evaluated the relationship between the intestinal bacteria of the newborn and mode of delivery. Bottom Line: The intestines of newborns are colonized immediately after birth with bacteria, mainly from the mother. There is strong evidence suggesting that the type of bacteria plays an important role in the development of the immune system. The intestinal bacteria of infants delivered by cesarean delivery appear to be less diverse than the bacteria of vaginally delivered infants. The mode of delivery has a deep impact on the composition of the intestinal bacteria at the very beginning of human life.