Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor
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
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).
Karlowicz MG. Long-term Pulmonary Consequences of Elective Cesarean Delivery. JAMA. 2002;288(11):1352. doi:10.1001/jama.288.11.1350