Am J Perinatol
DOI: 10.1055/a-2650-1095
Original Article

Planned Primary Cesarean Delivery versus Attempted Labor in Low-Risk Pregnancies: Associations with Adverse Outcomes

Claudia J. Ibarra
1   Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
,
Han-Yang Chen
1   Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
,
Rachel L. Wiley
2   Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, San Diego, California
,
Hector Mendez-Figueroa
1   Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
,
Suneet P. Chauhan
3   Delaware Center of Maternal-Fetal Medicine of Christiana Care, Newark, Delaware
› Author Affiliations

Funding None.
Preview

Abstract

Objective

This study aimed to compare adverse outcomes among low-risk pregnancies with labor versus planned cesarean delivery (PL-CD).

Study Design

A population-based, retrospective cohort study used U.S. vital statistic data from 2016 to 2021 in low-risk individuals delivered at 37 to 41 weeks with nonanomalous, singletons. Labor status was categorized as no labor (PL-CD) or labor. The primary outcome was a composite neonatal adverse outcome (CNAO); secondary outcomes were a composite maternal adverse outcome (CMAO) and infant death. Additional analysis was performed to re-categorize labor status into three groups: no labor (PL-CD), labored with vaginal delivery (VD) and labored with intrapartum cesarean (IN-CD). Multivariable Poisson regression models were utilized to estimate adjusted relative risk (aRR) and 95% confidence intervals (CI).

Results

Among 22,685,620 live births during the study period, 13,686,776 (60.3%) were included: 6.0% had PL-CD, and 94.0% labored. The rates of CNAO and CMAO were 7.97 and 3.17 per 1,000 live births, respectively. Compared with PL-CD, the risk of CNAO (aRR: 0.58; 95% CI: 0.57–0.59), infant death (aRR: 0.59; 95% CI: 0.57–0.62) and CMAO were lower (aRR: 0.62; 95% CI: 0.60–0.64) among those that labored overall. Compared with PL-CD by route of delivery, the risk of CNAO (aRR: 0.47; 95% CI: 0.46–0.48) and CAMO (aRR: 0.45; 95% CI: 0.44–0.47) was lower among VD, but higher (CANO, aRR: 1.24; 95% CI: 1.21–1.26; CAMO, aRR: 1.75; 95% CI: 1.69–1.81) if delivered by IN-CD.

Conclusion

Among low-risk pregnancies, those who labored had a lower risk of composite adverse outcomes compared with those with planned cesarean, particularly if delivered vaginally.



Publication History

Received: 28 May 2025

Accepted: 06 July 2025

Accepted Manuscript online:
07 July 2025

Article published online:
24 July 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA