Timing of elective Caesarean section at term on neonatal morbidities
DOI:
https://doi.org/10.12809/hkjgom.23.2.343Keywords:
Cesarean section, Infant, newborn, Intensive care units, neonatal, Neonatal sepsis, Respiratory distress syndrome, newbornAbstract
Objective: To compare the incidence of neonatal morbidities with elective Caesarean sections at different weeks of gestation in Hong Kong.
Methods: Medical records of all women with an elective Caesarean section performed at gestational age ≥37 weeks in Queen Elizabeth Hospital, Hong Kong, between 1 January 2016 and 31 December 2018 were retrospectively reviewed. Adverse neonatal outcomes collected included respiratory distress syndrome, transient tachypnoea, persistent pulmonary hypertension, sepsis, and neonatal intensive care unit admission.
Results: A total of 1576 records were analysed. Overall, 74.68% of babies were delivered at 38 weeks’ gestation. The most common adverse neonatal outcome was transient tachypnoea (6.66%), followed by neonatal intensive care unit admission (5.90%), respiratory distress syndrome (5.26%), and sepsis (4.69%). Compared with babies born at 39 weeks’ gestation, those born at 37 weeks’ gestation were at increased risk of respiratory distress syndrome (odds ratio [OR]=5.348, p=0.024), neonatal intensive care unit admission (OR=3.938, p=0.027), a composite respiratory outcome (OR=3.402, p=0.007), and an overall composite outcome (OR=3.397, p=0.002).
Conclusion: Elective Caesarean delivery at 37 weeks’ gestation is associated with higher risks of respiratory distress syndrome and neonatal intensive care unit admission, compared with elective Caesarean delivery at 39 weeks’ gestation.
References
World Health Organization. Statement on Caesarean Section Rates. Available from: https://apps.who.int/iris/rest/bitstreams/714841/retrieve.
Hong Kong College of Obstetricians and Gynaecologists. Territory-Wide Audit in Obstetrics and Gynaecology 2014. Available from: https://www.hkcog.org.hk/hkcog/Download/Territory-wide_Audit_in_Obstetrics_Gynaecology_2014.pdf.
Tefera M, Assefa N, Mengistie B, Abrham A, Teji K, Worku T. Elective cesarean section on term pregnancies has a high risk for neonatal respiratory morbidity in developed countries: a systematic review and meta-analysis. Front Pediatr 2020;8:286.
Tita AT, Landon MB, Spong CY, et al. Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med 2009;360:111-20. DOI: https://doi.org/10.1056/NEJMoa0803267
Al Bizri A, Boghossian NS, Nassar A, et al. Timing of term elective cesarean section and adverse neonatal outcomes: a multi-center retrospective cohort study. PLoS One 2021;16:e0249557.
Pirjani R, Afrakhteh M, Sepidarkish M, et al. Elective caesarean section at 38–39 weeks gestation compared to > 39 weeks on neonatal outcomes: a prospective cohort study. BMC Pregnancy Childbirth 2018;18:140. DOI: https://doi.org/10.1186/s12884-018-1785-2
National Institute for Health and Care Excellence. Caesarean Birth. Available from: https://www.nice.org.uk/guidance/ng192.
Stock SJ, Thomson AJ, Papworth S; the Royal College of Obstetricians and Gynaecologists. Antenatal corticosteroids to reduce neonatal morbidity and mortality: Green-top Guideline No. 74. BJOG 2022;129:e35-60.
American College of Obstetricians and Gynaecologists. Cesarean Delivery on Maternal Request. Available from: https://www.acog.org/clinical/clinical-guidance/committeeopinion/articles/2019/01/cesarean-delivery-on-maternalrequest.
Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Timing of planned caesarean section at term. Available from: https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/GL2016_015.pdf.
Tse HM, Au Yeung KC, Lee HC, Yong SPY. The timing of elective caesarean section on neonatal respiratory outcome in Hong Kong. Hong Kong J Gynaecol Obstet Midwifery 2012;12:13-20.
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 Gynecol 2010;202:250.e1-8. DOI: https://doi.org/10.1016/j.ajog.2010.01.052
Ongun H, Ongun EA, Yolcular BO. Evaluation of respiratory problems according to week of delivery: a comparative analysis in infants of gestational age 37 weeks. Iran J Pediatr 2018;28:e59488. DOI: https://doi.org/10.5812/ijp.59488
Consortium on Safe Labor; Hibbard JU, Wilkins I, et al. Respiratory morbidity in late preterm births. JAMA 2010;304:419-25. DOI: https://doi.org/10.1001/jama.2010.1015
Hu Y, Shen H, Landon MB, Cheng W, Liu X. Optimal timing for elective caesarean delivery in a Chinese population: a large hospital-based retrospective cohort study in Shanghai. BMJ Open 2017;7:e014659. DOI: https://doi.org/10.1136/bmjopen-2016-014659
Glavind J, Kindberg SF, Uldbjerg N, et al. Elective caesarean section at 38 weeks versus 39 weeks: neonatal and maternal outcomes in a randomised controlled trial. BJOG 2013;120:1123-32. DOI: https://doi.org/10.1111/1471-0528.12278
Sotiriadis A, McGoldrick E, Makrydimas G, et al. Antenatal corticosteroids prior to planned caesarean at term for improving neonatal outcomes. Cochrane Database Syst Rev 2021;12:CD006614.
Gupta K, Rajagopal R, King F, Simmons D. Complications of antenatal corticosteroids in infants born by early term scheduled cesarean section. Diabetes Care 2020;43:906-8.
Räikkönen K, Gissler M, Kajantie E. Associations between maternal antenatal corticosteroid treatment and mental and behavioral disorders in children. JAMA 2020;323:1924-33. DOI: https://doi.org/10.1001/jama.2020.3937
Royal College of Obstetricians and Gynaecologists. Late Intrauterine Fetal Death and Stillbirth. Green-top Guideline No.55. Available from: https://www.rcog.org.uk/media/0fefdrk4/gtg_55.pdf.
Rosenstein MG, Cheng YW, Snowden JM, Nicholson JM, Caughey AB. Risk of stillbirth and infant death stratified by gestational age. Obstet Gynecol 2012;120:76-82. DOI: https://doi.org/10.1097/AOG.0b013e31825bd286
Darnal N, Dangal G. Maternal and fetal outcome in emergency versus elective caesarean section. J Nepal Health Res Counc 2020;18:186-9.
Yang XJ, Sun SS. Comparison of maternal and fetal complications in elective and emergency cesarean section: a systematic review and meta-analysis. Arch Gynecol Obstet 2017;296:503-12. DOI: https://doi.org/10.1007/s00404-017-4445-2
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Hong Kong Journal of Gynaecology, Obstetrics and Midwifery
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The Journal has a fully Open Access policy and publishes all articles under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) licence. For any use other than that permitted by this license, written permission must be obtained from the Journal.
