Elective Cesarean Group Research Articles

Neonatal outcomes following one previous caesarean section

Background/Aims Vaginal birth following a previous caesarean section is considered a safe option for subsequent births following personal planning and counselling. The aim of this study was to compare neonatal outcomes for both elective caesarean and vaginal birth after a previous caesarean section to aid decision making for women/pregnant people. Methods This quantitative study used retrospective data from low-risk pregnant people/women at term with one previous caesarean section (n=392). Logistic regression was used to determine the impact of mode of birth on neonatal outcomes. Further descriptive analyses were carried out to explore the results and reasons for admission to neonatal unit. Results Apgar scores were higher in the vaginal birth group compared to the elective repeat caesarean group. There were no differences in neonatal unit admissions by mode of birth. Conclusions There is minimal difference in neonatal outcomes, regardless of intention for either vaginal birth following a previous caesarean section or elective repeat caesarean. To fully investigate the factors that impacted Apgar scores and neonatal unit admissions for these groups, a much larger sample is needed.

Comparison of the Effect of Preoperative Anxiety on the Oxidative Stress Biomarkers in Umbilical Cord Blood After Vaginal and Cesarean Delivery

AbstractObjective This study examined the independent effect of delivery type and preoperative anxiety on placenta oxidative stress response.Materials and methods A total of 126 patients who gave birth were divided into two groups according to delivery type: vaginal delivery group (VD) (n=56) and elective cesarean section delivery group (CS) (n=70). The preoperative anxiety levels of pregnant women who came to the delivery room were evaluated with the State Anxiety Inventory (SAI) scale. Malonyldialdehyde (MDA), superoxide dismutase (SOD), total antioxidative status (TAS), total oxidative state (TOS), and oxidative stress index (OSI) levels in umbilical cord blood were compared according to preoperative anxiety level and type of delivery.Results The CS group had significantly higher MDA (0.88±0.15 versus 0.79±0.09, p=0.001) and TOS (8.37±1.81 versus 7.53±0.77, p=0.019) values compared to the VD group. TAS levels did not differ significantly between the groups. SOD levels were higher in VD group compared to CS group (p=0.049). When the factors affecting oxidative stress biomarkers are analyzed by regression analysis, factors affecting MDA were found to be SAI score (Beta=0.358), CS (Beta=0.212), the factor affecting SOD was found to be VD (Beta=0.318), the factors affecting TOS were found to be SAI score (Beta=0.317) and CS (Beta=0.183).Conclusıon Oxidative stress biomarker levels in umbilical cord blood and preoperative anxiety levels were higher in patients who underwent elective caesarean section than those who delivered vaginally. Preoperative anxiety was the factor that increased oxidative stress biomarkers of umbilical cord blood the most.

Influence of Gestational Age and Mode of Delivery on Neonatal Outcomes in Prenatally Diagnosed Isolated Congenital Diaphragmatic Hernia

Aim: The optimal gestational age (GA) at delivery and mode of delivery (MoD) for pregnancies with fetal congenital diaphragmatic hernia (CDH) is undetermined. The impact of early term (37–38 weeks 6 days) versus full term (39–40 weeks 6 days) and MoD on immediate neonatal outcomes in prenatally diagnosed isolated CDH cases was evaluated. Material and Methods: A retrospective chart review of pregnancies evaluated and delivered with the prenatal diagnosis of CDH between July 1, 2008, and December 31, 2018. The primary outcome was survival to hospital discharge. Secondary outcomes included neonatal intensive care unit (NICU) length of stay (LOS), extracorporeal membrane oxygenation (ECMO) requirement and need for supplemental oxygen at day 30 of life. Results: A total of 296 patients were prenatally evaluated for CDH and delivered in a single center during the study period. After applying exclusion criteria, data were available on 113 women who delivered early term and 72 women who delivered full term. Survival to hospital discharge was comparable between the 2 groups – 83.2% in the early term versus 93.1% in the full term (p = 0.07; 95% CI of 0.13–1.04). No difference was observed in any other secondary outcomes. MoD was stratified into spontaneous vaginal, induced vaginal, unplanned cesarean and scheduled cesarean delivery with associated neonatal survival rates of 74.2, 90.6, 89.7 and 88.2%, respectively, p = 0.13. The 5-min Apgar score was higher in the elective cesarean group (7.94) followed by the induced vaginal delivery group (7.8) compared to 7.17 and 7.18 in the spontaneous vaginal and unplanned cesarean groups, respectively (p = 0.03). The GA and MoD did not influence survival to hospital discharge nor NICU LOS in multivariate analysis. Conclusions: Though there were no significant differences in neonatal outcomes for early term compared to full term deliveries of CDH neonates, a trend toward improved survival rates and lower ECMO requirements in the full term group may suggest an underlying importance GA at delivery. Further studies are warranted to validate these findings.

BLOOD LOSS DURING EMERGENCY CAESAREAN SECTION OF PLACENTA PREVIA IS MORE AS COMPARED TO ELECTIVE CAESAREAN SECTION

Background: Placenta Previa is one of the major obstetric complication. It is a serious condition that may lead to severe morbidity and mortality. The risk of cesarean and blood loss, particularly, in emergency cesarean section.
 Objective: To compare the mean blood loss and need for blood or blood products with emergency versus elective cesarean section in females with placenta previa.
 Study design: Cohort study.
 Settings: Department of Obstetrics & Gynaecology.
 Duration: 3 months (April to June 2020).
 Method: Sample size of 70 patients were enrolled in the study through Non Probability, Consecutive Sampling. Patients of age 20-40 years, presented >24 weeks of pregnancy, with diagnosis of placenta previa were included. Then females were booked and were followed-up in OPD till delivery. Emergency cesarean section was done if active labor and bleeding started while elective cesarean was done on given date for delivery. Intraoperative blood loss and need for blood or blood components transfusion was noted. Data was recorded on proforma and analyzed by using SPSS version 22.
 Results: The mean age of females in emergency group was 30.80 ± 4.36 years and mean age of females in elective group was 31.06 ± 3.76 years. The mean gestational age of females at delivery in emergency group was 35.74 ± 2.89 weeks and in elective group was37.54 ± 0.70 weeks. The average blood loss during emergency caesarean section was 1471.43 ± 891.65 ml while during elective cesarean section, average blood loss was 1042.86 ± 402.41 ml (p<0.05). In emergency caesarean group, 7 (20%) did not require blood transfusion while 28 (80%) required blood transfusion. In elective caesarean group, 21 (60%) did not require blood transfusion while 14 (40%) required blood transfusion (p<0.05).
 Conclusion: Though this study, we found significantly higher blood loss and need for blood transfusion in emergency caesarean section as compared to elective caesarean sections for placenta previa.

Does the Caesarean Section Impact on 11β HSD2 and Fetal Cortisol?

Purpose: Comparison of the activity of 11beta-hydroxysteroid dehydrogenase type 2 in the placenta and the umbilical cord blood cortisol level between caesarean sections with or without uterine contraction and vaginal delivery groups. Cortisol is the main stress hormone responsible for the normal adaptation of the neonate to extrauterine life. The disorders resulting from a dysfunction of the 11β-HSD 2–cortisol system can explain the higher risk of developing diseases in children born by caesarean section. Methods: 111 healthy, pregnant women in singular pregnancy at term of delivery were included into the study. The study comprised 11β-HSD 2 in placental tissue from 49 pregnant women delivering by elective caesarean section and 46 pregnant women delivering by vagina. In 16 cases of the elective caesarean section, regular uterine contractions were declared. Cortisol level was estimated in umbilical cord blood directly after delivery. Results: We found no statistically significant differences in the activity of 11β-HSD 2 in placentas delivered via caesarean sections (29.61 on average in elective caesarean sections and 26.65 on average in intrapartum caesarean sections) compared to vaginal deliveries (31.94 on average, p = 0.381), while umbilical cord blood cortisol in the elective caesarean sections group was significantly lower (29.86 on average) compared to the vaginal deliveries (55.50 on average, p < 0.001) and intrapartum caesarean sections (52.27 on average, p < 0.001). Conclusions: The model of placental 11β-HSD 2 activity and umbilical cord blood cortisol concentration seems to be significant in conditions of stress associated with natural uterine contractions in labour.

Determinants of cesarean-related complications: high number of repeat cesarean, operation type or placental pathologies?

Background Cesarean delivery (CD) is one of the most common operations worldwide. Vaginal birth after cesarean (VBAC) could be a solution to decrease increased CD rates. On the other hand, risks of VBAC on maternal and neonatal outcomes drifts physicians and patients to a scheduled CD. Successive CDs, especially after the 3rd operation, increase complications for the fetus and the mother. Operation type (emergency or elective CD) could be a risk factor of increased morbidities, like placental implantation anomalies. Evaluation of these conditions related to complications and morbidities were investigated. Material and methods: Women who underwent the fourth and more repeat CD in Bursa Yuksek Ihtisas Training Research Hospital between March 2016 and December 2019 were retrospectively reviewed. Pre-operative characteristics, per-operative and post-operative complications were reviewed. Patients were separated into groups as operational type, repeat cesarean number, and major morbidities. A comparison between groups was evaluated. Results: A total of 46.048 women gave birth, of which 17,721 underwent CDs with a rate of 38%. The rate of primary CD was 18%. The number of the fourth or more CD performed was 854. The number of patients who underwent fourth and fifth or more CD and of these operational data could be accessed was 599 and 145, respectively. The overall complications were detected as severe adhesions (n: 220), preterm delivery (n: 91), stillbirth (n: 9), admission to NICU (n: 98), bladder injury (n: 10), uterine scar dehiscence (n: 6), uterine rupture (n: 6), uterine atony (n: 26), blood transfusion requirement (n: 68), preterm delivery (n: 91), placenta previa totalis (n: 24), morbidly adherent placenta (n: 14), hysterectomy (n: 12), partial uterine resection (n: 2), uterus-conserving interventions (n: 26). The number of patients with major morbidity was 105. Emergency cesarean performed in 339 of 744 patients. A comparison of the emergency cesarean group with elective repeat cesarean group revealed no significant difference in operative adverse outcomes. Comparing patients between 4th repeat CD with 5th and more CD revealed a significant difference in severe adhesion, morbidly adherent placenta and hysterectomy. Previa totalis were detected in 24 patients. All of them experienced major morbidity with 12 of them underwent hysterectomy. The rest of them performed Uterus-conserving treatments (B-Lynch Suture, Bacri Balloon, Hypogastric artery ligation ) and a total of 51 units of packed red blood cells and 32 units of Fresh Frozen Plasma were transfused to 9 (37%) of 24 patients. Conclusion: The major risk factor of the morbidity is placenta previa whose incidence has dramatically increased after 3rd cesarean. Emergency cesarean did not increase the complication rate in the present study. Fourth and more repeat CDs ought to be performed by experienced obstetricians in high-equipped tertiary hospitals.

Reasons for previous Cesarean deliveries impact a woman\u2019s independent decision of delivery mode and the success of trial of labor after Cesarean

BackgroundCesarean delivery rates are increasing globally with almost half of them occurring due to a previous Cesarean delivery. A trial of labor after Cesarean (TOLAC) is considered a safe procedure, but most eligible women instead undergo Cesarean before 39 weeks of gestation. Lack of education about TOLAC is often associated with increased repeat Cesarean. To reveal the safety and feasibility of TOLAC, we conducted this observational, prospective study with women’s independent decisions. We aimed to clarify the relationship between their chosen mode of delivery and the reason for their previous Cesarean. Additionally, we have tried to identify maternal and obstetric factors associated with failed TOLAC to improve its success rate.MethodsThis was a prospective, observational study of 1086 pregnant women with at least one previous Cesarean delivery. Of these, 735 women met our TOLAC criteria (Table 1), and then, could choose TOLAC or repeat Cesarean after receiving detailed explanations regarding the risks and benefits of both procedures. The primary outcomes were the number of successful TOLAC procedures and 5-min Apgar scores < 7 for the trial of labor after Cesarean group and elective Cesarean group. We collected the maternal and neonatal data including the reasons of previous Cesarean.ResultsIn total, 64.1% of women chose TOLAC. The success rate was 91.3%. The uterine rupture rate was 0.6%. There were no significant differences in the rate of Apgar scores at 5 min < 7 between both groups. Histories of experience of labor in previous Cesarean delivery were observed in 30 and 50% of women who chose TOLAC and repeat Cesarean, respectively (p < 0.05). Factors related to failed TOLAC included ≥40 weeks of gestation (odds: 5.47, 95% CI: 2.55–11.70) and prelabor rupture of membranes (PROM) (odds: 4.47, 95% CI: 2.07–9.63).ConclusionsTOLAC is a favorable delivery option for both mothers and neonates when women meet criteria and choose after receiving detailed explanations. Women who experience PROM or ≥ 40 weeks of gestation, their modes of delivery should be reconsulted.

Naproxen Sodium for Pain Control With Intrauterine Device Insertion: A Randomized Controlled Trial.

Naproxen Sodium for Pain Control With Intrauterine Device Insertion: A Randomized Controlled Trial.

ASSOCIATION BETWEEN TIME OF NEONATAL DISCHARGE WITH MODE OF DELIVERY

BACKGROUND AND OBJECTIVE: Early discharge requires the close follow-up of outpatients in the clinic or at home within 48 hours after discharge. Given the importance of follow-up after early discharge of infants and also lack of accurate statistics on the rate of early discharge in our country, this study aimed to determine the rate of early discharge of newborns in Babol-Clinic Hospital from March 2013 to March 2014 METHODS: This cross-sectional study was conducted on all the neonates born in Babol Clinic Hospital in Mazandaran, Iran in 2013. Newborns were selected via census sampling. In addition, a questionnaire was used to collect the data on the length of hospital stay, mode of delivery, gender, birth weight, Apgar scores, gestational age, method of anesthesia, need for resuscitation, and maternal diseases for each infant. Early discharge and very early discharge were defined in newborns released before 48 and 24 hours after birth, respectively. Data analysis was performed in SPSS V.20 using T-test, Chi-square, Fisher's exact test, and Cox regression analysis, and p<0.05 was considered significant. FINDINGS: In total, 2,562 infants born in Babol Clinic Hospital were enrolled in this study, 2,451 of whom (96%) were discharged before 48 hours, and 1,829 newborns (71.5%) were discharged before 24 hours after birth. In normal delivery method groups, 9 (4.25%) neonates routine discharged, 36 (16.98%) neonates early discharged and 167 (78.77%) neonates were very early discharged. Elective and emergency cesarean group, 68 (3.9%) neonates and 34 (5.62%) neonates normal discharge, 428 (24.53%) neonates and 158 (26.12%) neonates early discharged and 1 249 (71.58) neonates and 413(68.26%) neonates were very early discharged respectively (p=0.02). 92% of deliveries were by Caesarean section and 8% were the normal vaginal delivery. CONCLUSION: According to the results of this study, almost all the neonates born in Babol Clinic Hospital had early or very early discharge, and only a few cases (4%) were hospitalized for more than 48 hours. Therefore implement of close follow-up or home visitis recommended.

Historic cohort study on mode of delivery of a macrosomic baby: the women's point of view.

A historic cohort study was conducted to evaluate satisfaction with childbirth of a macrosomic baby according to mode of delivery. All 559 nulliparous women who delivered a neonate weighing >4000 g between 2008 and 2012 were included. The degree of women's satisfaction with childbirth after elective cesarean, vaginal delivery or cesarean during labor was assessed using a five-level scale. Immediate neonatal and maternal outcomes were retrieved from clinical records. Long-term maternal outcomes were evaluated using four questionnaires on urinary incontinence, anal incontinence, and sexual functioning. Ninety-nine women underwent elective cesarean, whereas 460 attempted a vaginal delivery. In the latter group, 276 women delivered vaginally, whereas 184 underwent a cesarean during labor. Long-term outcomes were assessed in 273 women (49%; elective cesarean, n = 55; vaginal delivery, n = 135; cesarean in labor, n = 83) after a mean 3-year follow up. The proportion of long-term stress or mixed urinary incontinence was, respectively, 8%, 34%, and 12%, whereas that of anal incontinence was 7%, 19%, and 6%. Sexual functioning was similar in the three groups. No major neonatal complications were observed. When pooling the vaginal delivery and the cesarean in labor groups, the likelihood of being satisfied with childbirth was 63% in the "attempted vaginal delivery" group and 85% in the elective cesarean group (adjusted risk ratio, 0.72; 95% CI 0.61-0.84). About one-third of women attempting a vaginal delivery of a macrosomic baby, would choose an elective cesarean if they could turn back time.

PRUEBA DE TRABAJO DE PARTO EN CESAREADA ANTERIOR

Antecedentes: Los riesgos relativos y absolutos asociados a la prueba de trabajo de parto en cesareadas anteriores han originado un aumento en la tasa de cesáreas, a pesar de las evidencias que demuestran la seguridad y los beneficios de la prueba de trabajo de parto. Objetivos: Determinar los resultados materno-perinatales de las gestantes con antecedente de una cesárea previa, a quienes se les indicó prueba de trabajo de parto. Diseño: Estudio de cohortes, retrospectivo, analítico. Institución: Unidad de Medicina Fetal, Instituto Nacional Materno Perinatal, Lima, Perú. Participantes: Gestantes con antecedente de una cesárea previa y atendidas en el parto. Intervenciones: Se revisó 584 historias clínicas de mujeres con antecedente de una cesárea previa que dieron a luz entre enero y diciembre de 2007. Se excluyó las pacientes que no cumplían los criterios de inclusión y se obtuvo los resultados materno perinatales de las 266 gestantes restantes. Principales medidas de resultados: Resultados materno-perinatales. Resultados: De 266 gestantes con antecedente de una cesárea previa y sin contraindicación para el parto vaginal, a 188 (70,7%) se les indicó cesárea electiva repetida y a 78 (29,3%), prueba de trabajo de parto. De estas últimas, 51 (65,3%) tuvieron éxito. Los resultados maternos muestran en el grupo de cesárea electiva una rotura uterina, una histerectomía y dos casos de hemorragia posparto. En el grupo prueba de trabajo de parto, no hubo rotura uterina, histerectomía, hemorragia posparto. No hubo muertes maternas en algún grupo. En cuanto a los resultados perinatales, no hubo caso de muerte intraútero anteparto o intraparto, Ápgar menor de 7 a los 5 minutos, ni muertes neonatales, en ninguno de los dos grupos. Conclusiones: No hubo diferencia estadísticamente significativa en los resultados materno-perinatales de las gestantes con antecedente de una cesárea previa a quienes se indicó prueba de trabajo de parto, comparados con quienes se indicó cesárea selectiva repetida. La tasa de éxito del grupo prueba de trabajo de parto fue 65,3%.

Predicting why women have elective repeat cesarean deliveries and predictors of successful vaginal birth after cesarean

ObjectiveTo compare the characteristics of women who select elective repeat cesarean rather than trial of labor after cesarean (TOLAC) for delivery, and to determine individual predictors for success and failure within a TOLAC group and observe differences in maternal and neonatal morbidity. MethodsThe present descriptive, retrospective, observational study was performed in a regional obstetric unit in the United Kingdom. Data were collected from the Northern Ireland Maternity System database on all women who gave birth between April 2010 and April 2012, and had a previous cesarean delivery, and statistical analysis was performed. ResultsIn total, 893 patients were included in the study: 385 underwent TOLAC and 493 underwent elective repeat cesarean. On comparison, women in the elective repeat cesarean group had a shorter inter-delivery interval and fewer had had a previous vaginal delivery (P<0.005). Predictors for success in the TOLAC group included previous vaginal delivery and a longer inter-delivery interval (P<0.05). Successful vaginal birth after cesarean (VBAC) did not have higher rates of maternal morbidity. ConclusionThe majority of patients (56%) chose elective repeat cesarean rather than TOLAC, which has long-term implications both clinically and financially. A validated prediction model might improve patient counseling and identify women with a high likelihood of successful VBAC.

The evaluation of cord blood interleukin-1β levels in normal and caesarean deliveries

The aim of this prospective study was to establish the cord blood interleukin 1β (IL-1β) levels and asphyxia enzymes in term newborns and their relationship between delivery modes. We investigated whether cord blood level of IL-1β could be used as a reliable marker for detecting hypoxic stress and to determine the optimal cut-off level for IL-1β. The study was designed prospectively. Cord blood samples were obtained at the time of delivery from 75 noninfected full-term neonates for the purpose of measuring cord blood levels of IL-1β. Women were classified into three groups according to the mode of delivery (20 vaginal delivery, 29 urgent caesarean section (with foetal distress) and 26 elective caesarean section). All cases were followed-up by hospitalization. Umbilical cord sampling was carried out for IL-1β, umbilical artery gas parameters and other asphyxia enzymes at the time of delivery. Cord blood IL-1β was measured by enzyme-linked immunosorbent assay. The perinatal outcomes of the cases were recorded after birth. Demographic characteristics, neonatal outcomes and laboratory findings were compared in all the three groups. IL-1β levels showed statistically significant difference between groups (p < 0.01). The relationship was found between IL-1β cord blood levels and the mode of delivery. IL-1β levels of urgent caesarean section group were significantly higher than elective caesarean section and normal delivery group (p:0.001 and p:0.001, respectively). Normal delivery levels were significantly higher than the elective caesarean group (p:0.001). Urgent section (foetal distress) and vaginal delivery (labour) were each associated with elevated IL-1β cord blood levels in noninfected full-term neonates, while only elective caesarean section was associated with decreased IL-1β levels. For the evaluation of newborns at high risk for perinatal hypoxic stress, cord blood IL-1β levels may lead the way. On the other hand, the mode of delivery may be associated with the effects on the immune system. Further investigations with larger patient groups are required to confirm our results.

Quantitative comparison of entropy analysis of fetal heart rate variability related to the different stages of labor

BackgroundThe interpretation of the fetal heart rate (FHR) signal considering labor progression may improve perinatal morbidity and mortality. However, there have been few studies that evaluate the fetus in each labor stage quantitatively. AimTo evaluate whether the entropy indices of FHR are different according to labor progression. Study designA retrospective comparative study of FHR recordings in three groups: 280 recordings in the second stage of labor before vaginal delivery, 31 recordings in the first stage of labor before emergency cesarean delivery, and 23 recordings in the pre-labor before elective cesarean delivery. SubjectsThe stored FHR recordings of external cardiotocography during labor. Outcome measuresApproximate entropy (ApEn) and sample entropy (SampEn) for the final 2000 RR intervals. ResultsThe median ApEn and SampEn for the 2000 RR intervals showed the lowest values in the second stage of labor, followed by the emergency cesarean group and the elective cesarean group for all time segments (all P<0.001). Also, in the second stage of labor, the final 5min of 2000 RR intervals had a significantly lower median ApEn (0.49 vs. 0.44, P=0.001) and lower median SampEn (0.34 vs. 0.29, P<0.001) than the initial 5min of 2000 RR intervals. ConclusionsEntropy indices of FHR were significantly different according to labor progression. This result supports the necessity of considering labor progression when developing intrapartum fetal monitoring using the entropy indices of FHR.

La présentation du siège singleton à terme. À propos d’une série continue de 418 cas

The obstetrical management of term breech presentations in singleton pregnancies usually opposes the advocates of elective caesarean section to vaginal birth. Twelve years after the Term Breech Trial and 6 years after the PREMODA study, the aims of this work are to analyze neonatal results according to route of delivery chosen before labour and to evaluate professional practices in an important continuous series of cases.This is a retrospective study including all breech singleton pregnancies that delivered at our level III labour ward at 37 weeks of amenorrhea, from 1st January 2005 to 31st December 2011. All data were analyzed in intention to treat.Of the 418 patients included during the study period, 52% of them delivered vaginally. In 81% of cases, a vaginal birth trial was accepted and 64% of these patients delivered vaginally. Severe morbidity and neonatal mortality judgement criteria were not significantly different between the vaginal birth trial and the elective caesarean groups. Our obstetrical department continues to provide residents with specific training in the management of breech presentations. In this study, 60% of breech deliveries were performed by residents.Although a limited statistical power, this study did not bring any proof in favour of elective caesarean for singleton term breech presentations. Training residents in the management of vaginal breech deliveries is feasible and highly recommended.

Depression and Perceived Social Support Evaluation in Iranian Pregnant Women Who Underwent Elective or Non-Elective Cesarean Delivery in 2011-2012

Introduction: Psychological factors play an important role in post-partum period and they may cause some disorders such as post-partum depression. These disorders may be correlated with delivery modes. This study was designed to evaluated depression and social support in women who underwent elective or non-elective Cesarean delivery. Methods and Materials: This case-control study was conducted on 140 pregnant women who referred to Shairaaty Hospital, Isfahan, between 2011 and 2012. Seventy participants had a maternal request for Cesarean. Multi-dimensional Scale of Perceived Social Support (MSPSS-P) questionnaire and Beck Depression Inventory (BDI) were used for social support and depression evaluation in the subjects. Result: Mean age in the elective Cesarean group was 27.48 ± 4.25 years and mean age in group B was 27 + 4.16 years. 31.5% of the women who underwent elective Cesarean and 27.2% of the participants who underwent Cesarean with a medical reason had depression according to the BDI (p value =0.515) and there was no significant difference between the groups in the social support subscales (p value &gt;0.05). Conclusion: According to our results and previous reports, there was no association between the delivery mode and post-partum psychological disorders; however, family support may decrease these disorders.[GMJ. 2012;1(2):72-77]

Maternal and infant outcome after caesarean section without recorded medical indication: findings from a Swedish case–control study

To compare maternal complications and infant outcomes for women undergoing elective caesarean sections based on a maternal request and without recorded medical indication with those of women who underwent spontaneous onset of labour with the intention to have a vaginal birth. Retrospective register study. Sweden; Medical Birth Register used for data collection. A case-control study of 5877 birth records of women undergoing caesarean sections without medical indication and a control group of 13774 women undergoing births through spontaneous onset of labour. The control group was further divided into women who actually had a vaginal birth and women who ended up with an emergency caesarean section. Maternal complications occurred more frequently among women undergoing caesarean section with odds ratios (OR) for bleeding complications of 2.5 (95% CI 2.1-3.0) in the elective caesarean group and 2.0 (95% CI 1.5-2.6) in the emergency caesarean group. The OR for infections was 2.6 in both groups. Breastfeeding complications were most common in women having an elective caesarean section: 6.8 (95% CI 3.2-14.5). Infant outcomes showed a higher incidence of respiratory distress with an OR of 2.7 (95% CI 1.8-3.9) in the elective caesarean section group compared with infants born by emergency caesarean section. The risk of hypoglycaemia was at least twice as high for infants in the caesarean group. Caesarean sections without medical indication as well as emergency caesarean sections were associated with higher risks for maternal and infant morbidity.

108: Maternal and perinatal consequences of a primary elective cesarean delivery

To estimate cumulative risks of maternal and perinatal morbidity associated with the choice of elective cesarean for a first delivery. A decision analytic model was designed to compare major adverse outcomes across a woman's reproductive life associated with the choice of primary elective cesarean versus a trial of labor at a first delivery. Maternal outcomes assessed included maternal transfusion, hysterectomy, thromboembolism, operative injury, and death. Perinatal outcomes assessed included cerebral palsy (CP) and permanent brachial plexus (BP) palsy in the offspring. Choosing an initial cesarean resulted in a 0.3% increased risk of a major adverse maternal outcome in the first pregnancy. In each subsequent pregnancy, the difference in maternal morbidity increased between strategies, such that by the fourth pregnancy, the cumulative risk of a major adverse maternal outcome was nearly 10% in the elective primary cesarean group, three times higher than among women who initially underwent a trial of labor. Although the choice of an initial cesarean resulted in 2.4 and 0.41 fewer cases of CP and BP palsy, respectively, per 10,000 women in the first pregnancy, by a fourth pregnancy, the risk of either adverse neonatal outcome was higher among offspring of women who had chosen the initial elective cesarean (0.368% vs. 0.363%). Maternal morbidity associated with the choice of a primary elective cesarean increases in each subsequent pregnancy and is greater in magnitude than that associated with the choice of trial of labor. These increased risks are not offset by a substantive reduction in the risk of neonatal morbidity.Tabled 1Composite adverse outcomes per pregnancy

Increased elective caesarean section rate is not associated with a decreased serious morbidity rate for twins ≥ 32 weeks’ gestation

To assess neonatal and maternal morbidity in twins ≥ 32 weeks’ gestation, related to the changes in planned mode of delivery, a retrospective cohort study was performed, including 185 twin births delivered in the Atrium Medical Centre, Heerlen, during the years 2003–2008. The results were compared with those of an earlier study from our department during the period 1999–2002. Compared with the 1999–2002 cohort, the elective caesarean section rate significantly increased from 17.7% to 36.8%. The secondary caesarean rate significantly decreased from 15.9% to 8.8%, but increased from 1.2% to 3.3% for only twin B. No significant differences in serious neonatal morbidity rates for twins A and B were found between both study periods, neither in the elective caesarean group, nor in the planned vaginal birth group. Serious maternal morbidity was not significantly increased in both groups compared with the 1999–2002 cohort.

Persistent pulmonary hypertension of the newborn following elective cesarean delivery at term

Objective. To evaluate the frequency of persistent pulmonary hypertension of the newborn (PPHN) following elective cesarean at greater than 34 weeks' gestation in an academically affiliated community hospital.Methods. Retrospective cohort study involving chart review of 300 newborns with PPHN between 1999 and 2006. Infants less than 34 weeks' or with congenital anomalies were excluded. Subjects were divided into two groups: (1) intended vaginal delivery and (2) elective cesarean.Results. A total of 125 neonates were included. In all, 46 were delivered vaginally, 53 by cesarean after a trial of labor, and 26 by elective cesarean. No statistically significant differences were noted between groups in birth weight, gestational age, or length of stay. The crude relative risk (RR) of PPHN in cesareans prior to labor (elective cesareans) when compared to intended vaginal deliveries was 2.0 (95% CI 1.3–3.1). The RR of PPHN in elective cesareans when compared to spontaneous labor resulting in vaginal deliveries was 3.4 (95% CI 2.1–5.5). The adjusted RRs for these outcomes comparing the same delivery groups when considering gestational age at birth (less vs. equal to or more than 37 weeks') were 2.2 (95% CI 1.4–3.4) and 3.7 (95% CI 2.3–6.1), and birth weight (less vs. equal to or more than 2500 g) were 1.9 (95% 1.3–3.0) and 3.4 (95% CI 2.1–5.5), respectively. The incidence of PPHN in the elective cesarean group was 6.9 per 1000 deliveries. The number of cesareans to be avoided to prevent one case of PPHN in this cohort was 387 (number needed to harm, 95% CI 206.8–3003.1).Conclusions. Our findings include a high rate of PPHN following elective cesarean delivery, and suggest that physicians should consider this added morbidity when performing elective cesareans.