In March an expert panel determined there was "insufficient evidence to evaluate fully" the risks and benefits of cesarean delivery performed at maternal request, as compared with planned vaginal delivery (see In the News, June). Now, a study evaluating national data on more than 5.7 million infants born between 1998 and 2001 sheds some light on the risks of cesarean delivery in women with no indicated medical risk or complications.
"No indicated risk" meant that labor and delivery were free of complications; only full-term, singleton, vertex-presentation infants born to women who had no medical risk factors were included. The overall neonatal mortality rate was almost three times higher after cesarean than after vaginal delivery (1.77 versus 0.62 per 1,000 births); for multiparous mothers, the rate was 3.7 times higher for cesarean than for vaginal delivery. Even after excluding from the analysis those causes of neonatal death (congenital malformations, which accounted for 54% of deaths, and intrauterine hypoxia) that could be indications for performing a cesarean and also raise the risk of newborn death, the neonatal mortality rate for cesarean deliveries remained more than twice that for vaginal deliveries.
The authors note that "although the neonatal mortality rate for this group of low-risk women remains low regardless of the method of delivery, the resulting increase in the cesarean section rate may inadvertently be putting a larger population of neonates at risk" for death for reasons that remain unclear. They call for better documentation of risk indications on birth certificates and more research into the clinical reasons for infant death with cesarean delivery.
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Household products may be hazardous to your health. Volatile organic compounds (VOCs) are found in many household cleansers and products, including air fresheners, toilet bowl deodorants, pesticides, paints, varnishes, and mothballs. Using data collected from 1988 to 1994 in the Third National Health and Nutrition Examination Survey of more than 950 adults, researchers evaluated whether blood levels of VOCs were associated with pulmonary dysfunction. One compound-1,4-dichlorobenzene- had consistent, significant negative effects on lung function, particularly forced expiratory volume in one second. The complete study is available at http://www.ehponline.org/members/2006/9019/9019.html.
No Gulf War syndrome. After reviewing 850 studies, an Institute of Medicine (IOM) panel concluded that there is no evidence to support a unique Gulf War syndrome. The panel did find that veterans who served in Operation Desert Storm in 1990 and 1991 experience increased rates of ailments, including depression, posttraumatic stress disorder, anxiety, and substance abuse. Deployed veterans may also be at higher risk for amyotrophic lateral sclerosis (ALS). Some studies suggest there is an elevated risk of birth defects among children born to veterans, as well as of miscarriages and ectopic pregnancies. Veterans exposed to smoke from oil-well fires show a higher incidence of asthma. The committee recommends continued monitoring of Gulf War veterans for adverse outcomes, especially cancer, ALS, children with birth defects, miscarriages, ectopic pregnancy, and psychiatric disorders. (Read the IOM report at http://www.nap.edu/catalog/11729.html.)
Fran Mennick, BSN, RN