Elective Cesarean Section Group Research Articles

High mobility group box 1 and markers of oxidative stress in human cord blood.

Parturition induces considerable oxidative stress and many inflammatory mediators, such as high mobility group box 1 (HMGB1), are involved from the beginning of the pregnancy to birth. The aim of the present study was to evaluate serum cord blood concentration of diacron-reactive oxygen metabolites (d-ROM), biological antioxidant potential (BAP), and HMGB1 to investigate the perinatal oxidative status of neonates and correlation with mode of delivery, as well as the influence of labor. The subjects consisted of 214 neonates delivered at University Hospital "G. Martino", Messina, in a 6months period. Venous blood samples were collected from the umbilical cord after cord separation. Umbilical cord venous blood HMGB1 was significantly higher in the spontaneous vaginal delivery (SVD) group than in the elective or emergency cesarean section (CS) group (P = 0.018). Regarding labor, there was no significant difference in HMGB1 concentration in umbilical vein blood between the spontaneous and induced labor groups (P = 0.250). Furthermore, d-ROM was significantly different between the SVD group and the elective or emergency CS group (P = 0.044). BAP concentration, however, was not significantly different, not even with regard to mode of labor. Oxidation is higher in newborns delivered by SVD than in those delivered by CS, and HMGB1 may be involved in the mechanisms of birth, and responsible for decidual modifications that lead to birth.

Different concentration of human cord blood HMGB1 according to delivery and labour: A pilot study

ObjectiveOxidative stress is involved in several maternal conditions characterized both by an increase in free radicals synthesis and a parallel decrease in the antioxidant activity. Parturition induces considerable oxidative stress and many inflammatory mediators, among which HMGB1, are involved from the beginning of pregnancy to the birth of the infant. We evaluated serum cord blood HMGB1 levels in a population of neonates to investigate correlation with mode of delivery, as well as the influence of labour. Setting and patientsThe study subjects were 325 neonates delivered at University Hospital “G. Martino” of Messina over an 18-month period. Following cord separation, venous blood sampling was performed on umbelical cords. ResultsIn the cord venous blood, we found HMGB1 values significantly more elevated in spontaneous vaginal group when compared to elective or emergency caesarean section group. Regarding labour, umbilical cord venous blood HMGB1 levels were significantly higher in the spontaneous and induced labour group, compared to non-labouring women. ConclusionThese results could highlight a possible role of HMGB1 during birth time related to mode of delivery and labour.

Comparison Of Gastric PH In Emergency Versus Elective Caesarean Sections

Background: The volume of the gastric fluids and the gastric pH both are affected during pregnancy and surgery. The gastric fluid volume and pH are also affected by the mode of surgery (elective caesarean section and emergency caesarean). Objective: The predetermined aim of this study was to compare the gastric fluid pH in emergency with elective caesarean sections. Method: The study was conducted in Divisional Headquarters Teaching Hospital, Mirpur, Azad Kashmir and the sample population was consisted of 150 patients. The sample was divided into two groups, the patients with emergency caesarean section and elective caesarean section group. The gastric volume and gastric pH were detected in both groups of the study. Results: The group of the patients in the emergency caesarean section showed lower gastric pH value (2.16 ± 0.64) and the gastric acid volume was (26.33 ± 10.59). In comparison, the gastric pH value for elective caesarean section was (4.56 ± 1.28) and gastric acid volume was (11.65 ± 4.37) respectively. The results were found to be significant at p-value <0.05. Conclusion: The results of the study concluded that gastric volume was significantly higher and gastric pH was significantly lower in emergency caesarean section as compared to elective caesarean section.

Does antenatal steroids treatment prior to elective cesarean section at 34-37weeks of gestation reduce neonatal morbidity? Evidence from a case control study.

To determine whether antenatal corticosteroids administration prior to an elective cesarean section (ECS) at 34-37weeks gestation is associated with improved neonatal outcome. A case control study of women with singleton pregnancies who underwent ECS between 34 and 37weeks of gestation including two groups: (1) study group in which patients were treated with betamethasone prior to ECS (n=58) and (2) control group matched for gestational age at delivery in which patients did not receive betamethasone (n=107). Neonatal measures including respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), oxygen requirement, admission to the special care unit, hypoglycemia, hyperbilirubinemia and length of hospitalization were determined in both groups. Composite respiratory morbidity was defined as the presence of either RDS, TTN, mechanical ventilation or oxygen requirement. There was no significant difference in the rate of composite respiratory morbidity nor its components between patients with and without betamethasone treatment (25.9 vs. 25.2%, respectively, p=0.9). Antenatal treatment with corticosteroids prior to ECS at 34-37weeks of gestation did not result in significant reduction in neonatal respiratory morbidity in our cohort of patients.

Management of Breech Presentation: Green-top Guideline No. 20b.

Management of Breech Presentation: Green-top Guideline No. 20b.

Impact of antenatal oxytocin infusion on neonatal respiratory morbidity associated with elective cesarean section.

IntroductionThis study was designed to estimate respiratory morbidity associated with elective cesarean section (ECS) and to determine the effect of antenatal oxytocin exposure on this morbidity.Material and methodsNine hundred and sixty-five neonates ≥ 37 weeks’ gestation delivered by cesarean section during 1 year were included in this retrospective study and classified into two groups according to oxytocin exposure before cesarean deliveries. Respiratory morbidity for each group was recorded and statistically analyzed.ResultsTransient tachypnea of newborn (TTN) was significantly more frequent in group II (ECS group) than in group I (cesarean section after oxytocin exposure) (8.19% vs. 2.92%; respectively, p = 0.0006). Mechanical ventilation, continuous positive airway pressure (CPAP) and oxygen therapy were significantly more frequent in group II than in group I (1.78%, 2.14% and 4.28% versus 0.44%, 0.58% and 1.46%, respectively; p = 0.039, and p = 0.033 and p = 0.009, respectively). The number of newborns admitted to the neonatal unit and neonatal intensive care unit (NICU) was significantly higher in group II than in group I (6.41% and 2.14% vs. 2.05% and 0.58%, respectively; p = 0.001 and p = 0.033, respectively). Surfactant, fluid therapies and parenteral nutrition were significantly more frequent in group II than in group I (2.14%, 4.28% and 2.49% vs. 0.15%, 1.46% and 0.73%, respectively; p = 0.001, p = 0.009 and p = 0.02, respectively).ConclusionsNeonatal respiratory morbidity associated with ECS significantly decreased after antenatal oxytocin exposure. A significant reduction of neonatal respiratory morbidity would be achieved if ECS were performed after 39 weeks’ gestation.

Perinatal determinants of D-dimer levels in a cross-sectional study of low risk pregnant women.

To examine perinatal determinants of the antenatal levels of D-dimers. Cross-sectional study of 760 low risk pregnant women recruited into five gestational groups. Variables examined in antenatal groups included maternal age, body mass index, parity, smoking, family history venous thromboembolism (VTE) and previous use of the oral contraceptive pill (OCP). Onset of labour and mode of delivery were also examined in the post-natal group. D-dimer levels in group 4 (38-40 + 6) were significantly lower in the women with a history of taking the OCP when compared to those that had not taken it in the past (P = 0.027). In the day 2 post-natal group, the median level of D-dimer was significantly higher in primparous when compared to multiparous women (P = 0.015). The median D-dimer levels were significantly lower in the elective Caesarean section group in comparison to spontaneous onset (P = 0.003) and induction of labour (P = 0.016). When the mode of delivery was examined, the median D-dimer levels were significantly lower in those that had an elective Caesarean section when compared to normal vaginal delivery (P = 0.008) and instrumental vaginal delivery (P = 0.007). Women post elective Caesarean section had a significantly lower D-dimer than those after emergency Caesarean section (P = 0.008). There are some significant differences in D-dimer levels when certain perinatal determinants are examined. This work is potentially beneficial to the future diagnosis of VTE in pregnancy as it supports previously published recommended D-dimer levels for the diagnosis of VTE in pregnancy.

Serial Change in Cervical Length for the Prediction of Emergency Cesarean Section in Placenta Previa.

PurposeTo evaluate whether serial change in cervical length (CL) over time can be a predictor for emergency cesarean section (CS) in patients with placenta previa.MethodsThis was a retrospective cohort study of patients with placenta previa between January 2010 and November 2014. All women were offered serial measurement of CL by transvaginal ultrasound at 19 to 23 weeks (CL1), 24 to 28 weeks (CL2), 29 to 31 weeks (CL3), and 32 to 34 weeks (CL4). We compared clinical characteristics, serial change in CL, and outcomes between the emergency CS group (case group) and elective CS group (control group). The predictive value of change in CL for emergency CS was evaluated.ResultsA total of 93 women were evaluated; 31 had emergency CS due to massive vaginal bleeding. CL tended to decrease with advancing gestational age in each group. Until 29–31 weeks, CL showed no significant differences between the two groups, but after that, CL in the emergency CS group decreased abruptly, even though CL in the elective CS group continued to gradually decrease. On multivariate analysis to determine risk factors, only admissions for bleeding (odds ratio, 34.710; 95% CI, 5.239–229.973) and change in CL (odds ratio, 3.522; 95% CI, 1.210–10.253) were significantly associated with emergency CS. Analysis of the receiver operating characteristic curve showed that change in CL could be the predictor of emergency CS (area under the curve 0.734, p < 0.001), with optimal cutoff for predicting emergency cesarean delivery of 6.0 mm.ConclusionsPrevious admission for vaginal bleeding and change in CL are independent predictors of emergency CS in placenta previa. Women with change in CL more than 6 mm between the second and third trimester are at high risk of emergency CS in placenta previa. Single measurements of short CL at the second or third trimester do not seem to predict emergency CS.

The Betadine trial - antiseptic wound irrigation prior to skin closure at caesarean section to prevent surgical site infection: A randomised controlled trial.

Surgical site infections (SSIs) occur in around 10% of women following a caesarean section. Efforts to reduce SSI include wound irrigation with povidone-iodine (PVI), but studies are nonconclusive, mostly old and few on women having caesarean section (CS). To assess povidone-iodine (PVI) (Betadine) irrigation of wound prior to skin closure in reducing incidence of SSI after CS. Our hypothesis was that there would be no benefit with its use in reducing SSIs. A randomised controlled trial with 3027 women. Women having CS were allocated to receive PVI irrigation or no irrigation after closure of fascia and before skin closure. Women were followed up to four weeks to assess for SSI. Main outcome measure was surgical site infection. The two groups (1520 in Betadine and 1507 on no Betadine group) were well balanced. The incidence of SSI was similar in the two groups (9.5% vs 9.8%, RR 0.97; 95% CI 0.78-1.21). There was no difference between groups (2.6% vs 2.0%, RR 1.29, 95% CI 0.81-2.06 Betadine vs no Betadine, respectively) in readmission for wound infection requiring intravenous antibiotics; this was so in both the elective CS group as well as CS in labour group. PVI irrigation after the closure of fascia and before closure of skin is of no benefit in the prevention of SSI in women undergoing CS.

Study of maternal and fetal outcome in elective and emergency caesarean section

Introduction: Caesarean section is one of the most performed surgical procedures all over the world. The present study was conducted to determine the maternal & neonatal outcome and complications in two groups of pregnancy among women with elective and emergency cesarean section. So that measures can be taken to reduce morbidity and mortality in near future. Material & Methods: A prospective observational study carried out in department of Obstetrics and Gynecology, M.G.M Medical College and M.Y. Hospital ,Indore (M.P). All patients who underwent caesarean section are divided into two groups as per the timing of procedure in emergency or electively. The two groups were compared on the basis of age, parity, indication, booking status, intra operative & post op complications, and maternal & fetal outcome. Results: The incidence of caesarean section was 30.25%. The proportion of elective and emergency caesarean was 21.63% and 78.37% respectively. All of the complications were significantly higher in emergency group in terms of both maternal and fetal outcome. Conclusion: The incidence of caesarean section is high in MGM medical college Indore and the overall complication rate is higher in emergency caesarean than elective caesarean section group.

The influence of the obstetrical condition on canine neonatal pulmonary functional competence.

To compare the influence of the obstetrical condition on neonatal respiratory performance, to estimate surfactant synthesis through lecithin and sphingomyelin ratio (L/S) in amniotic fluid of pregnant bitches and correlate the L/S with the respiratory condition during the first hour of life. Prospective randomized study. University veterinary teaching hospital and private referral centers. In accordance to the condition at birth, puppies from 25 healthy bitches aged 2-6 years were allocated into: Eutocia Group--EUT (n = 19 neonates and 14 bitches); Dystocia Group--DYS (n = 8 neonates and 5 bitches) and Elective Cesarean Section Group--CS (n = 12 neonates and 11 bitches). Amniotic fluid was drawn from amniotic sac and lecithin (L) and sphingomyelin (S) were measured by high performance liquid chromatography to obtain the L/S ratio. Neonatal physical examination was performed at 1, 5, and 60 minutes after delivery, and included the assessment of respiratory rate (RR) and respiration effort (RE). CS group had significantly lower amniotic L/S ratio when compared to EUT and DYS. There were no significant differences between vaginal groups (EUT versus DYS) in respect to L/S ratios. RE of eutocic neonates improved promptly, while RE of DYS and CS groups improved only 1 hour following birth. Moreover, amniotic L/S ratio positively correlated with RR after 60 minutes. We identified a possible influence of the delivery method on the final surfactant maturation process. Thus, neonates born by elective CS prior to the onset of expulsive uterine contractions should have their respiratory parameters carefully monitored. Additionally, we propose that assessment of respiratory parameters 1 hour following birth can serve as a practical means to indirectly estimate pulmonary maturation (ie, surfactant synthesis) in puppies.

Mode of delivery after obstetric anal sphincter injury

ObjectiveTo assess the effect of vaginal delivery and caesarean section on faecal symptoms and structure and function of anal sphincter in women who sustained obstetric anal sphincter injuries (OASIS) in their previous pregnancy and were advised about the mode of delivery based on faecal incontinence symptoms, anal manometry and endoanal ultrasound. Study designIt is a descriptive study on a cohort of women who had OASIS from 2006 to 2013. They were assessed after OASIS and during subsequent pregnancy with a questionnaire, endoanal ultrasound and anal manometry. Vaginal delivery was recommended to asymptomatic women with normal investigations. Elective caesarean section was recommended to women with faecal symptoms, anal sphincter defects of more than 30° or low resting or incremental anal pressures. All women were reassessed after subsequent delivery. ResultsFifty women who had pregnancies after OASIS, were seen after OASIS, during subsequent pregnancy and after the second delivery. 15 women had faecal symptoms after OASIS. The external, internal and combined anal sphincter defects were seen in 13, 11 and 9 women respectively. Low resting and incremental pressure were seen in 15 and 11 women respectively. Caesarean section was done in 22 women and 28 women delivered vaginally. Worsening of faecal symptoms and reduction in anal pressures were not observed in planned vaginal delivery or elective caesarean section groups. Faecal symptoms were worse with reduced anal pressures in three women from the planned caesarean section group. One of the women had a vaginal delivery and two women had emergency caesarean section at 7cm and 10cm dilatation. There were no new sphincter defects or recurrent OASIS in any of the women in the study group. ConclusionDecision about the mode of delivery of pregnancy after OASIS based on symptoms, anal manometry and endoanal ultrasound helps in preserving the anal sphincter function and avoiding unnecessary caesarean sections. Further follow-up of these patients is essential to evaluate the long-term effects of this decision.

Global and single gene DNA methylation in umbilical cord blood cells after elective caesarean: a pilot study

ObjectiveTo evaluate global and single gene methylation patterns as a sign for epigenetic modulation of the immune system in infants born by elective cesarean section (CS) and vaginal delivery (VD). Study designFor this prospective pilot study a two step approach was chosen. Initially 41 newborn infants comprising 23 delivered by VD and 18 delivered by elective CS were included. Global DNA methylation of umbilical cord blood was determined. In a second step, methylation status of 96 single genes linked to T cell activation, cytokine production, inflammatory response, and stem cell transcription was evaluated in 48 newborn infants, 20 delivered by VD and 28 delivered by CS. ResultsGlobal methylation did not differ significantly between CS and VD (p=0.732). The methylation status was low (threshold: ≤3%) for the majority of single genes (n=92) in both groups. FOXP3, CD7, ELA2, and IRF1 showed hypermethylation in both groups. In the CS group, ELA2 (p<0.001) and IRF1(p =0.017) showed significantly higher methylation compared to the VD group. ConclusionWe found no difference in global methylation between newborn infants in the VD group compared to the elective CS group. Methylation of single genes was significantly higher in newborn infants delivered by elective CS. Further research is needed to determine the significance of theses findings.

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.

ASSOCIATION OF APGAR SCORE WITH DELIVERY MODE IN THE NON DISTRESS NEWBORNS

The Apgar score is the most commonly used measure of newborn infant well-being. Infants of women with caesarean section were at increased risk of low Apg ar score and/or perinatal death. The aim of study w as to determine the impact of the cesarean section on Apg are score. This is a case-control study, which comp ared 100 Elective Cesarean Section (ECS) cases, with 199 uncomplicated Normal Vaginal Deliveries (NVD). All newborns were product of first or second pregnancy and they are full term and singleton babies. Apgar score in the minute 5 was measured in both groups. The descriptive and analytical statistics (X 2 and T test) were used. Average of fifth Apgarscore was 8.63±0.79 in NVD group and was 8.79±0.94 in ECS group, that there was no significant difference. About 76. 5% of the NVD neonates in minute 5 had Apgar scores of 9 and 10. While in cesarean group, 59% of the neona tes in minute 5 had Apgar scores of 9 and 10. There was no significant difference between minute five A pgar scores of the two groups. Therefore it is not acceptable that with ECS baby will have worse Apgar score.

New evaluation of fetal oxidative stress: measurement of the umbilical cord blood dimethyl sulfate-induced ascorbyl-free radical by an electron spin resonance method

Objective: The aim is to evaluate intrapartum fetal oxidative stress in real-time by umbilical cord blood dimethyl sulfate (DMSO)-induced ascorbyl-free radical (AFR) measured by an electron spin resonance (ESR) method.Methods: Seventy-five mothers delivering at gestational age after 37 weeks were recruited. They were divided into three groups: spontaneous vaginal birth (n = 27), elective cesarean section (CS) (n = 34), and emergency CS due to non-reassuring fetal status (n = 14). Umbilical artery (UA) and venous (UV) cord blood gas analysis was performed. Serum levels of DMSO-induced AFR (AFR/DMSO) that reflect vitamin C concentrations were measured by ESR spectroscopy.Results: Blood gas analysis showed no significant differences among the groups. UA-AFR/DMSO level of elective CS group was significantly lower compared with spontaneous delivery group (0.32 ± 0.12 versus 0.46 ± 0.14, p < 0.005). Emergency CS group showed significantly lower levels of UA-AFR/DMSO compared with elective CS group (0.25 ± 0.11 versus 0.32 ± 0.12, p < 0.005). UV-AFR/DMSO levels had no significant difference among the groups.Conclusions: It is suggested that fetal cord blood AFR/DMSO is a sensitive marker to assess fetal oxidative stress during delivery.

Effect of elective cesarean section on the risk of mother-to-child transmission of hepatitis B virus

BackgroundMany clinicians and hepatitis B virus (HBV)-infected pregnant women prefer elective caesarean section (ECS) to prevent mother-to-child transmission of HBV, since some studies found higher transmission of HBV in infants born by vaginal delivery (VD) than by cesarean section. However, other studies showed that ECS does not reduce the risk of being infected with HBV in infants. In this study, we aimed to clarify whether ECS may reduce the risk of mother-to-child transmission of HBV.MethodsTotally 546 children (1–7-year-old) born to 544 HBsAg-positive mothers from 15 cities and rural areas across Jiangsu Province, China, were enrolled. Of these children, 137 (2 pairs of twins) were born to HBeAg-positive mothers; 285 were delivered by ECS and 261 others by VD (one pair of twin in each group). HBV serologic markers were tested by enzyme or microparticle immunoassay.ResultsThe maternal and gestational ages, maternal HBeAg-positive rates, and children’s ages, gender ratios, hepatitis B vaccine coverage and administrations of HBIG were comparable between ECS and VD groups (all p >0.05). The overall prevalence of HBsAg in the 546 children was 2.4%, with 2.5% (7/285) and 2.3% (6/261) in those born by ECS and VD respectively (p = 0.904). Further comparison of chronic HBV infection in the 137 children of HBeAg-positive mothers showed that the HBsAg-positive rates in ECS and VD groups were 10.3% (7/68) and 8.7% (6/69) respectively (p = 0.750), while the mothers had similar HBV DNA levels (2.38 × 106 vs. 2.35 × 106 IU/ml, p = 0.586). Additionally, the overall rate of anti-HBs ≥10 mIU/ml in the children was 71.6%, with 72.3% and 70.9% in those born by ECS and VD respectively (p = 0.717).ConclusionsWith the recommended immunoprophylaxis against hepatitis B, ECS does not reduce the risk of mother-to-child transmission of HBV. Therefore, ECS should not be used in HBsAg-positive pregnant women to prevent mother-to-child transmission of HBV.

Effectiveness of tranexamic acid on blood loss in patients undergoing elective cesarean section: randomized clinical trial

Objective: Cesarean section is associated with more blood loss than vaginal delivery. This could increase the risk of morbidity and mortality especially among anemic women. The objective of the trial is to assess the possible effect of tranexamic acid on blood loss during and after elective cesarean section.Methods: We conducted a randomized controlled trial at Women's Health Hospital, Assiut University, Assiut, Egypt. All pregnant women with singleton fetus planned to have elective cesarean section at ≥37 wks gestation were randomized to receive 1 g tranexamic acid slowly intravenously over 10 min before elective cesarean section group or not. Blood loss was measured during and for two hours after operation. Any side effects, complications, medications, changes in vital signs and duration of hospital stay were recorded. This study is registered, number ACTRN12612000313831.Results: Seven hundred and forty women were randomized (373 in study group and 367 in control group). Mean total blood loss was 241.6 (SE 6.77) ml in the tranexamic acid group versus 510 (SE 7.72) ml in the control group. The mean drop in hematocrit and hemoglobin levels were statistically significantly lower in the tranexamic acid group than in the control group. There were no statistically or clinically significant differences in other outcomes.Conclusions: Pre-operative use of tranexamic acid is associated with reduced blood loss during and after elective cesarean section. This could be of benefit for anemic women or those who refuse blood transfusion.

Perinatal Morbidity and Risk of Hypoxic-Ischemic Encephalopathy Associated With Intrapartum Sentinel Events

Objective To examine perinatal morbidity and rate of hypoxic-ischemic encephalopathy in infants exposed to intrapartum sentinel events. Study Design Retrospective cohort study from 2000-2005. Perinatal mortality, perinatal morbidity and rate of hypoxic-ischemic encephalopathy were compared in 3 groups of infants exposed to different risk factors for perinatal asphyxia (sentinel events, nonreassuring fetal status, elective cesarean section). Results Five hundred eighty-six infants were studied. Perinatal mortality was 6% in the sentinel event group and 0.3% in the nonreassuring fetal status group (relative risk, 2.4; 95% confidence interval, 1.95–2.94). Perinatal morbidity was 2-6 times more frequent in infants exposed to sentinel events; the incidence of hypoxic-ischemic encephalopathy was 10%, compared with 2.5% in the nonreassuring fetal status group (relative risk, 1.93; 95% confidence interval, 1.49–2.52). No infant in the elective cesarean section group died, had perinatal morbidity, or developed encephalopathy. Conclusion Intrapartum sentinel events are associated with a high incidence of perinatal morbidity and hypoxic-ischemic encephalopathy.

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.