Comparison of maternal and neonatal outcome in elective lower segment cesarean section done at 38 and 39 weeks
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20171436Keywords:
Elective caesarean section, Maternal outcome, Neonatal outcomeAbstract
Background: Time to perform elective LSCS is a relevant issue related to mother and foetus. LSCS can be done from 37 weeks onwards because foetal lungs mature by then. But foetuses born at 37 weeks of gestation have more risk of developing respiratory problems, transient tachypnoea of new born, hypothermia, hypoglycaemia and NICU admission.The purpose of this study is to find out appropriate gestational age at which elective LSCS can be performed without adverse maternal and neonatal outcome.
Methods: This is an observational comparative study done on 209 antenatal women who underwent elective caesarean section from December 2014 to January 2016.Patients were divided into two groups after taking consent. Maternal parameters like formation of lower uterine segment need for blood transfusion. Neonatal parameters like Apgar score, respiratory distress syndrome and NICU admission with indication and duration were analyzed by chi-square test. Gestational Age and Pre-Op Hb and Post-Op Hb were analyzed by independent ‘t’test.
Results: In this study 55% of the pregnant women belong to 38 weeks,45% belongs to 39 weeks. The formation of lower uterine segment was statistically significant and the need for blood transfusion was slightly increased at 39 weeks. But there was no significant difference in Apgar score, Respiratory distress, NICU admission comparing both study groups.
Conclusions: Elective caesarean section can be done safely at 38 weeks without affecting maternal and perinatal outcome.
References
F Gary C, Kenneth JL, Steven LB , John CH, Dwight JR, Catherine YS. Cesarean delivery and peripartum hysterectomy. In: Diane MT, George DW , Jodi SD, Barbara LH, Mala SM , James MA et al. Williams Obstetrics. 23rd ed. New York: McGraw-Hill Medical;2010,2005,2001:544.
Dutta DC. Operative Obstetrics. In: Hiralal Koner, editors. Text Book of Obstetrics. 6thed. Culcutta:New Central Book Agency;2004:588-9 .
Konar H. Text book of obstetrics. 7th ed. New central book agency publication; 2012:468-9 Kolkata.
Tita ATN, Landon MB, Spong CY, Lai Y, Leveno KJ, Varner MW et al. Timing of elective repeat cesarean delivery at term and neonatal outcomes. New Eng J Med.2009;360(2):111-20.
Parilla BV, Dooley SL, Jansen RD. Iatrogenic respiratory distress syndrome following elective repeat cesarean delivery. Obstet Gynecol.1993;83:392-5.
American College of Obstetricians and Gynecologists. Cesarean delivery on maternal request. Committee opinion no. 559. Obstet Gynecol. 2013;121:904-7.
Roberts CL, Nicholl MC, Algert CS, Ford JB, Morris JM, Chen JS. Rate of spontaneous onset of labour before planned repeat caesarean section at term. BMC Pregnancy and Childbirth. 2014;14:125.
Cohen M, Carson BS. Respiratory morbidity benefit of awaiting onset of labor after elective cesarean section. Obstet Gynecol.1985;65(6):818-24.
Tita ATN, Lai Y, London MB, Spong CY, Leveno KJ, Varner MW et al. Timing of elective repeat cesarean delivery at term and maternal perioperative outcomes. Obstet Gynecol. 2011;117:280-6.
Chiossi G, Lai Y, Landon MB, Spong CY, Rouse DJ, Varner MW. Timing of delivery and adverse outcomes in term singleton repeat cesarean deliveries. Obstet Gynecol. 2013;121(3):561-9.
Nahar K. Indications of caesarean section - study of 100 cases in Mymen Singh Medical College Hospital. J Shaheed Suhrawardy Medical College. 2012;1(1):6-10.
Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2006;19(3):CD004454.
Glavind J, Henriksen TB, Kindberg SF, Uldbjerg N. Randomised Trial of planned caesarean section prior to versus after 39 weeks: unscheduled deliveries and facility logistics - a secondary analysis. 2013;8(12):e84744.
Ghartey K, Coletta J, Lizarraga L, Murphy E, Ananth CV, Gyamfi-Bannerman C. Neonatal respiratory morbidity in the early term delivery. Am J Obstet Gynecol. 2012;207(4):292.e1-4.
Doan E, Gibbons K, Tudehope D. The timing of elective caesarean deliveries and early neonatal outcomes in singleton infants bore 37-41 weeks gestation. ANZJOG. 2014;54:340-7 .
Wilmink FA, Hukkelhoven CWPM, Lunshof S, Mol BWJ, Post JAM van der, Papatsonis DNM. Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: a 7-year retrospective analysis of a national registry. Am J of Obstet Gynecol. 2010;202(3):250.e1-250.e8.
Sperling LS, Henriksen TB, Ulrichsen H, Hedegård M, Møller H, Hansen V et al. Indications for cesarean section in singleton pregnancies in two Danish counties with different cesarean section rates. Acta Obstet Gynecol Scand.1994;73(2):129-35.
Dahlgren LS, von Dadelszen P, Christilaw J. Caesarean section on maternal request: risks and benefits in healthy nulliparous women and their infants. J Obstet Gynaecol Can. 2009;31:808-17.
Mazzoni A, Althabe F, Liu NH, Bonotti AM, Gibbons L, Sánchez AJ et al. Women’s preference for caesarean section: a systematic review and meta-analysis of observational studies. BJOG. 2011;118(4):391-9.
Hourani M, Ziade F, Rajab M. Timing of planned caesarean section and the morbidities of the newborn. N Am J Med Sci.2011;3(10):465–8.
Mylonas I,FrieseK.The indications for and risks of elective cesareansection. DtschArzteblInt. 2015;112:489-95.
Bakr AF, Abbas MM. Severe respiratory distress in term infants born electively at high altitude. BMC Pregnancy and Childbirth. 2006;6:4.
Okeke TC, Onah N, Ikeako Lc, Ezenyeaku CCT, Nwogu Ikojo E. Maternal and fetal outcome of elective caesarean section at 37-38 weeks versus 39 completed weeks of gestation in Enugu, Southeast Nigeria. American Journal of Clinical Medicine Research. 2013;1(2):32–4.
Zanardo V, Simbi AK, Franzoi M, Soldà G, Salvadori A, Trevisanuto D. 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, Villers MS, Johnson DD, Simpson KN. Timing of elective repeat cesarean delivery at term and neonatal outcomes: a cost analysis. Am J Obstet Gynecol. 2010;202(6);632.e1-632.e6
