Increased pneumothorax with elective C-section

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The rate of elective C-section is increasing in the United States and is very high in some other countries. Although a repeat C-section after a previous C-section is the most common indication for an elective C-section, the number of C-section deliveries for no apparent medical reason or at parental request is increasing. The number of C-sections prior to 39 completed weeks of pregnancy also is increasing. The rationale for some of these operative deliveries is to minimize risk for the fetus by avoiding labor. Zanardo et al report that the risk of a symptomatic pneumothorax requiring medical intervention increased to 2.9 per 1000 for elective C-section relative to rates of 1.5 per 1000 for emergency Cesarean section and 0.4 per 1000 for vaginal delivery. Pneumothorax was much more frequent for elective C-sections done prior to 38 weeks gestation. These results are not surprising as others have documented increased respiratory distress and problems with neonatal adaptation after elective C-section. Although infrequent, these adverse outcomes need to be balanced against the risks of labor and a vaginal delivery.