COMPARATIVE STUDY OF PERINATAL OUTCOME IN ELECTIVE CESAREAN DELIVERY AT 38 WEEKS GESTATION FOLLOWING A COURSE OF CORTICOSTEROIDS VERSUS ELECTIVE CESAREAN DELIVERY AT 39 WEEKS

Dr. Adusumilli Padmaja, Dr. V. Rajeevi, Dr. Aishwarya Musunuru

Abstract


Introduction: British and American societies in obstetrics recommend elective cesarean section to be scheduled after 39 completed weeks of gestation1, 2. However, approximately 16.5% of women,  go into labor during the 38th gestational week, which then requires an emergency cesarean before the scheduled date, giving rise to increased maternal and fetal morbidity6. Planning cesarean sections at 38 weeks would, therefore, enable these complications to be reduced, albeit at the risk of neonatal respiratory distress syndrome (RDS) and transient tachypnoea of the newborn (TTN)7.

 

Materials and method : This is a retrospective study in which data were collected from the records during two months(June and July  2019). Data from 25 women in each group were collected. The primary outcome was the rate of admission to the neonatal intensive care unit for respiratory distress.

 

Result: 1 baby (4%) from each group was admitted in NICU for respiratory distress. No significant difference were found in the incidence of neonatal sepsis, and neonatal intensive care unit stays between the two groups.

 

Conclusion: This pilot study suggests that planning an elective repeat cesarean delivery at 38 weeks gestational age with prior steroid dose prevents complications of emergency cesarean delivery and other complications like uterine rupture, fetal distress.


Keywords


cesarean delivery , neonate, transient tachypnoea of newborn, respiratory distress syndrome, neonatal intensive care unit , neonatal sepsis

Full Text:

PDF

References


NICE. Caesarean section. 2011. [http://guidance.nice.org.uk/CG132]. Accessed 15 February 2012.

American College of Obstetricians and Gynecologists. Cesarean delivery on maternal request. Committee opinion no. 559. Obstet Gynecol 2013;121:904–7.

Morrison JJ, Rennie JM, Milton PJ. Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section. Br J Obstet Gynaecol 1995;102:101–6.

Zanardo V, Simbi AK, Franzoi M, Solda G, Salvadori A, Trevisanuto D. Neonatal respiratory morbidity risk and mode of delivery at term: influence of timing of elective caesarean delivery. Acta Paediatr2004;93:643–7.

Hansen AK, Wisborg K, Uldbjerg N, Henriksen TB. Elective caesarean section and respiratory morbidity in the term and near‐term neonate. Acta Obstet Gynecol Scand 2007;86:389–94.6) Enquête nationale périnatale [Internet]. Available from: http://www.sante. gouv.fr/IMG/pdf/Les_naissances_en_2010_et_leur_evolution_depuis_2003. pdf.

Sananès, N., Koch, A., Escande, B., Aissi, G., Fritz, G., Roth, E., Weil, M., Bakri, A., Bolender, C., Meyer, N., Vayssiere, C., Gaudineau, A., Nisand, I., Favre, R., Kuhn, P. and Langer, B. (2017). Pilot randomized controlled trial comparing the risk of neonatal respiratory distress in an elective caesarean section at 38 weeks' gestation following a course of corticosteroids versus caesarean at 39 weeks. European Journal of Obstetrics & Gynecology and Reproductive Biology, 212, pp.54-59.

Tita AT, Landon MB, Spong CY, Lai Y, Leveno KJ, Varner MW, et al. Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med2009;360:111–20.

Wilmink FA, Hukkelhoven CW, Lunshof S, Mol BW, van der Post JA, Papatsonis DN. Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: a 7‐year retrospective analysis of a national registry. Am J Obstet Gynecol2010;202:250.e1

Phaloprakarn C, Tangjitgamol S, Manusirivithaya S. Timing of elective cesarean delivery at term and its impact on maternal and neonatal outcomes among Thai and other Southeast Asian pregnant women. J Obstet Gynaecol Res. 2016;42(8):936–43

Glavind J, Uldbjerg N. Elective cesarean delivery at 38 and 39 weeks: neonatal and maternal risks. Curr Opin Obstet Gynecol. 2015;27(2):121–7.

Doan E, Gibbons K, Tudehope D. The timing of elective caesarean deliveries and early neonatal outcomes in singleton infants born 37–41 weeks' gestation. Aust N Z J Obstet Gynaecol. 2014;54(4):340–7.

Spong CY. Defining “term” pregnancy: recommendations from the defining “term” pregnancy workgroup. JAMA. 2013;309(23):2445–6.

Glavind J, et al. Elective caesarean section at 38 weeks versus 39 weeks: neonatal and maternal outcomes in a randomised controlled trial. BJOG Int J Obstet Gynaecol. 2013;120(9):1123–32.

Terada K, et al. Timing of Elective Cesarean Singleton Delivery and Neonatal Respiratory Outcomes at a Japanese Perinatal Center. Journal of Nippon Medical School. 2014;81(4):285–8.

Balchin I, et al. Timing of planned cesarean delivery by racial group. Obstet Gynecol. 2008;111(3):659–66.

Wilmink FA, et al. Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: a 7-year retrospective analysis of a national registry. American journal of obstetrics and gynecology. 2010;202(3):250. e1–8

Zanardo V, et al. Neonatal respiratory morbidity risk and mode of delivery at term: influence of timing of elective caesarean delivery. Acta Paediatr. 2004;93(5):643–7.

Robinson CJ, et al. Timing of elective repeat cesarean delivery at term and neonatal outcomes: a cost analysis. American journal of obstetrics and gynecology. 2010;202(6):632. e1–6.

Patel RR, et al. Does gestation vary by ethnic group? A London-based study of over 122 000 pregnancies with spontaneous onset of labour. Int J Epidemiol. 2004;33(1):107–13.

Daniel S, et al. Comparison of fetal outcomes of emergency and elective caesarean sections in a teaching hospital in Kerala. Academic medical journal of India. 2014;2(1):32–6.

Stutchfield P, Whitaker R, Russell I, Antenatal Steroids for Term Elective Caesarean Section (ASTECS) Research Team. Antenatal betamethasone and incidence of neonatal respiratory distress after elective caesarean section: pragmatic randomised trial. BMJ 2005;331(September (7518)):662.

Salim R, Shalev E. Health implications resulting from the timing of elective cesarean delivery. Reprod Biol Endocrinol RBE 2010;8:68

Royal College of Obstetricians. Green Top Guideline No 7: Antenatal corticosteroids to reduce neonatal morbidity and mortality. London: Royal College of Obstetricians; 2010.

Venkatesh VC, Katzberg HD. Glucocorticoid regulation of epithelial sodium channel genes in human fetal lung. Am J Physiol 1997;273(July Pt (1)):L227– 33.

Allen V. Maternal morbidity associated with cesarean delivery without labor compared with spontaneous onset of labor at term. Obstet Gynecol 2003;102 (September (3)):477–82.

Peled Y, Melamed N, Chen R, Pardo J, Ben-Shitrit G, Yogev Y. The effect of time of day on outcome of unscheduled cesarean deliveries. J Matern-Fetal Neonatal Med 2011;24(August (8)):1051–4.

De Luca R, Boulvain M, Irion O, Berner M, Pfister RE. Incidence of early neonatal mortality and morbidity after late-preterm and term cesarean delivery. Pediatrics 2009;123(June (6)):e1064–71

Dessole S, Cosmi E, Balata A, Uras L, Caserta D, Capobianco G, et al. Accidental fetal lacerations during cesarean delivery: experience in an Italian level III university hospital. Am J Obstet Gynecol 2004;191(November (5)):1673–7.

Smith GC, Pell JP, Bobbie R. Caesarean section and risk of unexplained stillbirth in subsequent pregnancy. Lancet. 2003;362(9398):1779–84.

Wood S, et al. The risk of unexplained antepartum stillbirth in second pregnancies following caesarean section in the first pregnancy. BJOG Int J Obstet Gynaecol. 2008;115(6):726–31.

Doyle LW, Ehrenkranz RA, Halliday Late HL. Late (>7 days) postnatal corticosteroids for chronic lung disease in preterm infants. In: The Cochrane Collaboration, editor. Cochrane database of systematic reviews [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2014, doi:http://dx.doi.org/10.1002/ 14651858.CD001145.pub3 [cited 1 February 2016].

Doyle LW, Ehrenkranz RA, Halliday HL. Early (<8 days) postnatal corticoste- roids for preventing chronic lung disease in preterm infants. In: The Cochrane Collaboration, editor. Cochrane database of systematic reviews [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2016, doi:http://dx.doi.org/10.1002/ 14651858.CD001146.pub4 [cited 1 February 2016].

Vain NE, Szyld EG, Prudent LM, Wiswell TE, Aguilar AM, Vivas NI. Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: multicentre, randomised controlled trial. Lancet. 2004;364(9434):597-602.

Velaphi S, Vidyasagar D. Intrapartum and post delivery management of infants born to mothers with meconium stained amniotic fluid: evidence-based recommendations. Clinics Perinatology. 2006;33(1):29-42.


Refbacks

  • There are currently no refbacks.