Time Of Elective Cesarean Section Research Articles

Timing of elective Caesarean section at term on neonatal morbidities

Timing of elective Caesarean section at term on neonatal morbidities

Exploration of Factors Influencing Maternal Choice Without Medical Indication for Caesarean Section

Background: The rapid increase of caesarean sections has become the major public health problem. Caesarean section ratio is increasing day by day worldwide without knowing the factors with limited explanation that influence the rising trend without medical indications. Aims: To explore the driving factors which lead to the Caesarean Section and to evaluate the maternal choice without medical indication for Caesarean Section. Methodology: A Phenomenological qualitative approach was used with a semi structured open ended questionnaire. Sample size of ten pregnant women with a third trimester was used in this study. There was an individual in-depth interview with a time duration of 30-40 minutes. Purposive sampling technique was used in this study. Content analysis was done by using the Nvivo-10 software. Result: Participants were recruited from the urban and rural area. Interview session was 30-40 minutes which was convenient to the participant. All the interviews were audio tapes recorded. Interpretative Phenomenological analysis revealed five major themes which are: mother personal beliefs for caesarean section, lack of knowledge to make an informed choice, cultural and social influence, fear of labour pain, non-supportive behaviour of staff and management of health care system were made from these interviews. However, critical knowledge gaps were also observed among study obstetricians, particularly with regards to the indications for and timing of elective caesarean sections. Practical implication: The maternal choice of caesarean section without medical indications and the factors influencing the women decision-making process were complex. Therefore, these findings suggest that healthcare policy makers should attend to the factors that influence maternal choice about caesarean section and promote the normal vaginal birth among women. Conclusion: This study identifies the personal beliefs of mothers are the major factors for taking decisions regarding caesarean section. Furthermore, relative’s consultation with mother’s decision-making become the main influencer to conduct the caesarean section. There is the dire need to involve the relatives during the mother's antenatal period to support them to make the timely and right decision regarding the mode of birth. Keywords: Caesarean Section, Decision-Making, Influence, Factors, SVD, Pregnant Women

Bacterial Contamination of the Surgical Site at the Time of Elective Caesarean Section in Belgian Blue Cows-Part 2: Identified by 16Sr DNA Amplicon Sequencing.

This study aimed to describe the bacterial composition of the surgical site during elective caesarean sections (CSs) using the 16Sr DNA amplicon sequencing performed in parallel to bacterial culture. The study involved 13 Belgian blue cows of a previous dataset of 76 animals. Bacteriology was performed on swabs sampled from visceral and parietal peritoneum during the CS. Amplicon sequencing was performed in six samples chosen randomly among the swabs positive for bacteriology and seven among the culture-negative swabs. A total of 2542 bacterial operational taxonomic units belonging to 567 genera were identified. The most often identified genus and species were Mycoplasma (44%) and Mycoplasma wenyonii (36%), respectively. Results showed no difference in microbiota composition between the culture-positive and -negative samples. However, a difference was observed between the bacteriology and amplicon sequencing results. Indeed, seven out of nine cultured strains were not identified by amplicon sequencing in the samples in which they were cultured. In contrast to bacteriology, amplicon sequencing unveiled the presence of bacterial DNA in all elective CSs. The most identified DNA is most likely derived from the haematogenous spread of bacteria to the surgical site. Furthermore, the cultured bacteria were not the dominant species in the sample from which they were cultured.

Bacterial Contamination of the Surgical Site at the Time of Elective Caesarean Section in Belgian Blue Cows-Part 1: Identified by Bacterial Culture.

To improve the efficacy of preoperative antibiotics used in elective caesarean section (CS), we aimed to identify the bacteria contaminating the surgical site during this surgery. A study was conducted on 76 Belgian Blue cows. Bacteriology was performed on cotton swab sampled from the visceral and parietal peritoneum of each cow during the CS. Most of samples showed a negative culture (55/76; 72.37%), 19/76 (25%) were positive (p < 0.0001) and two samples were contaminated. In total, 32 isolates belonging to 18 species were identified. Most of them are aerobic (17/18; 94.44%) and half of them were gram-negative (G-). The most encountered bacteria were Acinetobacter sp. (6/32; 18.75%), Pseudomonas sp. (4/32; 12.5%), Aerococcus viridans (4/32; 12.5%), Psychrobacter sp. (3/32; 9.37%), and Escherichia coli (2/32; 6.25%). Among the identified isolates, 31/32 (96.87%) were aerobic and 1/32 (3.12%) was anaerobic (p = 0.0001). Furthermore, 20/32 (62.50%) strains were G− while 12/32 (37.5%) were gram-positive (G+) (p = 0.012). In fact, most of cultured strains were aerobic G− (20/32), 11/32 were aerobic G+ and 1/32 is anaerobic G+ (p < 0.0001). In conclusion, most of samples showed a negative bacteriology; however, aerobic G− strains were the most identified in positive swabs. Therefore, preoperative antibiotics should be aimed against these bacteria.

Maternal and Neonatal Outcome Following Elective Cesarean Section based on Progesterone Levels in High Risk Pregnant Dogs

Background: Elective cesarean section (CS) is an appropriate therapeutic modality in high risk pregnant dogs and it is scheduled following a drop in serum progesterone to less than 2ng/ml. However, a series of progesterone assays are required to confirm this drop in serum progesterone levels and this voluntary waiting period often results in foetal loss. The present study aimed to assess the innocuity of elective CS in dogs before the prepartum decline of serum progesterone, without administration of any priming agents. Methods: Elective CS was performed on an estimated day 63 of ovulation in seven high risk pregnant dogs with a serum progesterone level between 2-5 ng/ml (Group I) and maternal and neonatal outcomes were assessed in comparison with nine dogs that underwent elective CS at serum progesterone less than 2 ng/ml (Group II). Histopathological examination of lung tissue from dead neonates was performed to ascertain the presence of type II pneumocytes for assessing lung maturity. Result: Even though progesterone levels were above 2 ng/ml in dogs of Group I at the time of elective CS (3.11±0.29 ng/mL), the live birth rate was 96.97 per cent with acceptable neonatal survival. The histopathology of lung tissue from dead neonates from Group I revealed the presence of type II pneumocytes. The study suggested that elective CS in dogs could be done on day 63 after ovulation without compromising foetal lung maturity and a drop in serum progesterone level to less than 2 ng/ml was not mandatory for puppy survivability.

Prospective study of timing of elective caesarean section at different gestational ages to assess neonatal outcome in tertiary hospital, New Delhi

Timing of elective caesarean deliveries at term has become an important issue nowadays due to the progressive increase in caesarean delivery rates in recent years all over the world. Advanced maternal age at conception, legal considerations, assisted reproductive techniques and maternal request play an important role in the increased rates of elective repeated caesarean delivery. However the most important cause is the increased number of cases with repeated caesarean sections. Hence, study was undertaken with the aim to find correlation between gestational age of elective caesarean section performed at 38 weeks, 39 weeks, 40 weeks and neonatal outcome. A prospective comparative study consisting of 750 patients was done over a period of one and half year in Department of Obstetrics and Gynaecology Dr. Baba Saheb Ambedkar Hospital in Delhi. Neonatal outcomes were based on: Birth weight, apgar score (at 1 and 5 minutes), Respiratory complications, Hypothermia (axillary temperature

The interaction between protein kinase A and progesterone on basal and inflammation-induced myometrial oxytocin receptor expression.

Our previous work has shown myometrial PKA activity declines in term and twin-preterm labour in association with an increase in the expression of the oxytocin receptor (OTR). Here we investigate the action of cAMP/PKA in basal conditions, with the addition of progesterone (P4) and/or IL-1β to understand how cAMP/PKA acts to maintain pregnancy and whether the combination of cAMP and P4 would be a viable therapeutic combination for the prevention of preterm labour (PTL). Further, given that we have previously found that cAMP enhances P4 action we wanted to test the hypothesis that changes in the cAMP effector system are responsible for the functional withdrawal of myometrial P4 action. Myometrial cells were grown from biopsies obtained from women at the time of elective Caesarean section before the onset of labour. The addition of forskolin, an adenylyl cyclase activator, repressed basal OTR mRNA levels at all doses and P4 only enhanced this effect at its highest dose. Forskolin repressed the IL-1β-induced increase in OTR mRNA and protein levels in a PKA-dependent fashion and repressed IL-1β-activation and nuclear transfer of NFκB and AP-1. P4 had similar effects and the combination P4 and forskolin had greater effects on OTR and NFκB than forskolin alone. While PKA knockdown had no effect on the ability of P4 to repress IL-1β-induced OTR expression it reversed the repressive effect of the combination of P4 and forskolin and resulted in a greater increase than observed with IL-1β alone. These studies suggest that cAMP acts via PKA to repress inflammation-driven OTR expression, but that when PKA activity is reduced, the combination of cAMP and P4 actually enhances the OTR response to inflammation, promoting the onset of labour and suggesting that changes in the cAMP effector system can induce a functional P4 withdrawal.

The Impact of Timing of Elective Cesarean Delivery at Term in Neonatal Respiratory Morbidity.

The aim is to investigate the association between elective caesarean sections and neonatal respiratory morbidity and the importance of timing of elective caesarean sections&#x0D; Methods; Cohort study with prospectively collected data of all elective Caesarean sections on mothers with a gestational age of 37+0 weeks and more, that were performed in our Hospital from 1 January 2011 to 1 January 2017. Multiple pregnancies, fetuses with congenital anomalies, intrauterine deaths, and emergency Caesarean sections were excluded. Primary outcome measures of neonatal respiratory morbidity included transient tachypnea of newborn, respiratory distress syndrome, persistent pulmonary hypertension of the newborn.&#x0D; Results; 4290 infants were delivered by elective caesarean section at 37+0 and then after Compared with newborns from vaginal delivery, and emergency cesarean section an increased risk of respiratory morbidity was found for infants delivered by elective caesarean section at 37 +0 weeks’ gestation to 37+6 weeks (odds ratio 5.7 95% confidence interval 4.3 to 8.9), 38+0 weeks’ gestation to 38+6 weeks (2.8, 2.1 to 4.2 ), and 39+0 weeks’ gestation (2.1, 1.5 to 2.8). Also increasing the incidence of admission to the NICU with decreasing gestational age at term birth below the 39 weeks of gestation&#x0D; Conclusions: Compared with newborn delivered vaginally or by emergency caesarean sections, those delivered by elective caesarean section around term have an increased risk of respiratory morbidity. The relative risk increased with decreasing gestational age.

A systematic review and time-response meta-analysis of the optimal timing of elective caesarean sections for best maternal and neonatal health outcomes

BackgroundThe rate of caesarean sections (CS) has increased in the last decades to about 30% of births in high income countries. Many CSs are electively planned without an urgent medical reason for mother or child. An early CS though may harm the newborn. Our aim was to evaluate the gestational time point after the 37 + 0 week of gestation (WG) (after prematurity = term) of performing an elective CS with the lowest morbidity for mother and child by assessing the time course from 37 + 0 to 42+ 6 WG.MethodsWe performed a systematic literature search in MEDLINE, EMBASE, CENTRAL and CINAHL in November 2018. We included studies that compared different time points of elective CS at term no matter the reason for elective CS. Our primary outcomes were the rate of admissions to the neonatal intensive care unit (NICU), neonatal death and maternal death in early versus late term elective CS. Various binary and dose response random effects meta-analyses were performed.ResultsWe identified 35 studies including 982,749 women. Except one randomised controlled trial, all studies were cohort studies. We performed a linear time-response meta-analysis on the primary outcome NICU admission on 14 studies resulting in a decrease of the relative risk (RR) to 0.63 (95% CI 0.56, 0.71) from 37 + 0 to 39 + 6 WG. RR for neonatal death showed a decrease to 39 + (0–6) WG (RR 0.59 95% CI 0.43 to 0.83) and increase from then on (RR 2.09 95% CI 1.18 to 3.70) assuming a U-shape course and using a cubic spline model for meta-analysis of four studies. We only identified one study analyzing maternal death resulting in RR of 0.38 (95% CI 0.04 to 3.40) for 37 + 0 + 38 + 6 WG versus ≥39 + 0 WG.ConclusionOur systematic review showed that elective CS (primary and repeated) before the 39 + 0 WG lead to more NICU admissions and neonatal deaths, although death is rare and increases again after 39 + 6 WG. We did not find enough evidence on maternal outcomes. There is a need for more research, considering maternal outcomes to provide a balanced decision between neonatal and maternal health.Systematic review registrationRegistered in PROSPERO (CRD42017078231).

The effect of routine intraoperative tranexamic acid in elective cesarean section

Objective: To find the role of routine intraoperative tranexamic acid infusion at elective cesarean section.Study Design: Randomized case control studyStudy Setting: AlKarkh Maternity Hospital, Baghdad Iraq.Methodology: A total of 110 term pregnant women presenting in to our obstetric unit during the period between May, 2019 and January, 2020 and who were offered elective cesarean section, were randomly assigned to either receiving intraoperative tranexamic acid 1 gram in 100 milliliter saline infusion or saline infusion. Demographic characteristics were collected for all participants. Ten cases (1 in the tranexamic and 9 in the control group) were excluded as there were associated extensions of uterine incision in order to reduce confounders. A comparison of the outcomes of the two groups was done, it included an intraoperative blood loss determinator, a postoperative blood loss determinator, and an overall loss risk assessment. The corresponding parameters were the intraoperative surgical soaked packs count, average reduction in packed red blood cell volume 24 hour postoperatively, occurrance of postpartum hemorrhage and the overall need to receive blood transfusion. In term of associated side effects of receiving tranexamic acid, we sought whether there was any significant change in the blood pressure as well as the incidence of developing fever. Exclusion criterias were the contraindication to receive tranexamic acid assessed by referral to internist physician specialist review.Results: Confounding factors including patient’s age, parity and gestation length were taken into consideration and found to be similar between the two groups studied. There was a significant difference between the postpartum decline of packed red blood cell volume (PCV) (pvalue 0.001), with mean postpartum PCV in tranexamic group 35.2% versus 33.3% in the saline infusion group. 21.9% of women in the control group had decline of PCV exceeding 10% of preoperative value, versus only 3.3% in studied group. We found that the number of cesareans where additional packs got required was significantly less in tranexamic group (15.3% vs.22%, p=0.001), no cases in the tranexamic group did receive a blood transfusion vs. 7.3% in the saline group (pvalue 0.03).Slightly higher incidence of hypotensive episodes in the tranexamic group (27.1% vs. 12.2%, pvalue 0.07).Fever was found to be more likely following cesarean in the control group (34.1% vs. 18.6%, pvalue 0.06).Conclusion: The use of tranexamic infusion with inducton of anaesthesia at time of elective cesarean section is associated with less risk of intraoperative blood loss improving postoperative packed red blood cell volume decline significantly.

Adherence of Obstetrician to the Guideline Regarding the Timing of Elective Caesarean Sections and its Effect on the Neonatal Outcome

Objectives: Study the adherence of obstetrician to the guideline regarding the timing of elective caesarean sections. Study the effect of timing of the procedure on the neonatal outcome. Methods: In this cross-sectional observational study, involved 210 pregnant women who underwent elective caesarean section that subdivided into two groups according to gestational age at the time of caesarean section: Group A: < 39 weeks. Group B: ≥ 39 weeks. All neonates were examined by Pediatrician; neonates who required admission to the NCU were followed up until discharge. Results: 66.7% of elective caesarean section were performed 39 weeks gestation. The commonest indication of caesarean section in all gestational age was previous scar (s) followed by malpresentation. There was statistically higher admission to NCU among neonates who were delivered before 39 weeks gestation.There were 5 cases of neonatal death among neonates who were delivered before 39 weeks. No case of neonatal death occurs among those who were delivered at or after 39 weeks gestation. Conclusion: There is a high proportion of elective caesarean sections performed at earlier gestation than recommended by guideline. This was associated with increased neonatal mortality and morbidity.

Prospective Study of Intraoperative Intrauterine Contraceptive Device Application during Cesarean Section

Background: intrauterine contraceptive device (IUCD) is the most widely used method of reversible fertility regulation in the world. Over 100 million women worldwide use it for contraception. Many cultures have addressed the need for successful fertility regulation by embracing and expanding IUCD. IUCD is one of the most popular methods of contraception in Europe and Latin America, ranging from 10% to 30% of women contraception. In Cuba, Egypt, and North Korea, IUCD use accounts for more than 50% of contraceptive use. In China, 83% of married women used contraception and 36% of these women used IUCDs. Patients and methods: this prospective study was conducted at Al-Galaa Maternity Teaching Hospital, dated from 20/7/2016 to 20/1/2017, where 100 pregnant women attending the antenatal clinic were included according to special criteria. Results: according to our results, the PPIUCD was demonstrably safe, having no reported incidence of perforation, pregnancy with low rates of expulsion, pain abdomen, pelvic infection and lost strings. Continuation rate in intra-cesarean insertion was higher compared to vaginal insertion. Conclusion: routinely offering insertion of IUC at the time of elective cesarean section was popular among women. In addition, this study confirmed the low complication rate associated with insertion of IUCD at this time and an expulsion rate in keeping with that of insertion of IUC in women who are not postpartum

Comparison between Forceps, Single Blade Forceps and Manual Extraction of Fetal Head in Elective Caesarean Section: A Randomized Control Trial—Forceps Delivery in Cesarean Section

Objective: The fundal pressure exerted by the assistant to deliver fetal head is often painful to the patient. This study assesses the use of double blade forceps in delivery of fetal head at time of elective Cesarean Section (CS). Methods: A prospective single-blinded randomized controlled trial was conducted among 150 women with repeat elective CS at Ain Shams university hospital, Air Force Specialized hospital and October 6th university hospital. Women were classified into 3 groups (each 50 women). Forceps group: A double blade of forceps was used without fundal pressure. Single blade group: single blade of forceps was used assisted by fundal pressure. Manual group: manual extraction was used assisted by fundal pressure. The outcome of study were; Pain expectation score , pain score during delivery of head, unintended uterine extension, uterine vessels injury and need for additional stitches. The collected data were statistically analyzed using SPSS version 20. Results: High Statistically significant difference in pain score during delivery of head in favor of forceps group (P = 0.001). No differences were found among 3 groups as regarding pain expectation, uterine extension, uterine vessel injury and in need of haemostatic stitches (P > 0.05). Conclusion: Use of double blade forceps is less painful for the patients during delivery of head in CS.

Clinical analysis of respiratory distress syndrome of infants at term and near term delivered by elective cesa-rean section

Objective To access the incidence, clinical characteristics and the factors affecting therapy of respiratory distress syndrome (RDS) in the infants at term and near term delivered by elective cesarean section. Methods A retrospective cohort study among consecutively admitted infants with RDS at the Neonatal Intensive Care Unit of the Department of Neonatology, Xiangya Hospital, Central South University from Jan.2004 to Dec.2011 were conducted.The inborn infants at 36-42 weeks gestation with RDS, whom were delivered by Elective Cesarean Section from January 1st, 2004 to December 31st, 2011 were enrolled.These cases with the timing of elective caesarean section, gestational age, intrauterine infection, asphyxia at birth, which affecting the occurrence of RDS were compared. Results Fifty one infants were entered into the study, which were all met standard of Elective Cesarean Section.Among these infants, 33 cases (64.7%, 33/51 cases) were delivered by cesarean section without any reason.In these 51 cases, the constituent ratio of elective caesarean section in gestational age>39 weeks was lower than in gestational age >36 -<39 weeks, and the difference was significant (31.4% vs 68.6%, χ2=0.560, P<0.01). Asphyxia at birth was the main risk factors of term and near term with RDS (OR=7.306, 95%CI: 0.018-51.101, P=0.041). Compared to the infants whom born without asphyxia, the infants born with asphyxia usually came out to RDS right after born (χ2=0.080, P<0.01), required longer time of mechanical ventilation and had significant lower effective ratio (χ2=0.071, 8.843, all P<0.01). Conclusions Asphyxia is the first manifestations of term and near term infants with RDS.These infants often can be onset after birth. Key words: Term and preterm infant; Respiratory distress syndrome; Elective caesarean section; Asphyxia

Timing of elective caesarean section – are we deviating from nice guideline?

AimsTo find out the numbers of elective caesarean section carried out before 39 weeks gestations and the number of infant morbidity resulting from variation from the NICE guideline.BackgroundStudies have shown...

The morbidly adherent placenta

Randomized controlled trials and large cohort studies regarding the diagnosis and management of placenta accreta are lacking. This review examines the available evidence. Avoiding the placenta and leaving it attached at time of elective caesarean section to proceed with either delayed hysterectomy or conservative management is currently recommended. Recent literature has focussed on conservative management. Routine use of methotrexate in conservative management is no longer advocated. Use of emergency balloon catheter placement and embolization in tertiary centres where access to interventional radiology is immediately available may be favourable to prophylactic balloon catheter placement. Follow-up of patients undergoing conservative management should include ultrasonographic follow-up, human chorionic gonadotropin levels have been shown not to correlate with rate of placental resorption. Women with an antenatal diagnosis of placenta accreta should be managed in a tertiary facility with multidisciplinary input. To determine optimum management strategies, it is imperative that larger studies are carried out in the future. It is essential that the continual monitoring and containment of rising caesarean section rates becomes a priority to prevent a further increase in the incidence of placenta accreta.

Umbilical cord milking in term infants delivered by cesarean section: a randomized controlled trial

The study's objective was to compare hematocrit (Hct) levels at 36 to 48 h of age in term infants delivered by cesarean section exposed to immediate cord clamping or umbilical cord milking (UCM). In this randomized controlled trial, 24 women scheduled for elective cesarean section were randomized to either immediate clamping (<10 s) or UCM (milked × 5 by the obstetrical provider) at birth. All subjects received their allocated intervention. The milking group had a smaller placental residual blood volume (13.2±5.6 vs 19.2±5.4 ml kg(-1), P=0.01) and higher Hct levels at 36 to 48 h (57.5±6.6 vs 50.0±6.4 %, P=0.01). Five infants (42%) in the immediate group had a Hct of ≤47%, indicative of anemia. UCM results in placental transfusion in term infants at the time of elective cesarean section with higher Hct levels at 36 to 48 h of age.

Effect of weight gain during pregnancy on heart rate variability and hypotension during caesarean section under spinal anaesthesia

The purpose of this study was to assess the effect of antenatal weight gain on baseline heart rate variability and incidence of hypotension in singleton parturients with a normal pre-pregnancy body mass index, presenting at term for elective caesarean section under spinal anaesthesia. Sixty-six parturients, of ASA physical status 1-2, were allocated to one of three groups according to their weight gain during pregnancy: < 11 kg; 11-16 kg; and > 16 kg. Mean (SD) approximate entropy of baseline heart rate was significantly higher in the < 11 kg group (0.27 (0.11)) compared with the 11-16 kg group (0.14 (0.08)) and the > 16 kg group (0.14 (0.07)) (both p < 0.001). The incidence of hypotension in the < 11 kg group (17/22; 77%) was significantly higher than in the 11-16 kg group (7/22; 32%) (p = 0.006) and the > 16 kg group (8/22; 36%) (p = 0.01). We conclude that weight gain < 11 kg during pregnancy is associated with increased baseline heart rate variability and a higher incidence of hypotension at the time of elective caesarean section under spinal anaesthesia.

The timing of elective caesarean delivery between 2000 and 2009 in England.

BackgroundIn 2004, the National Institute for Clinical Excellence (NICE) recommended that an elective caesarean section for an uncomplicated pregnancy should not be carried out before 39 completed weeks due to increased risk of respiratory morbidity in newborns. We describe the trends and variation across 63 English NHS trusts in the timing of elective caesarean section (CS) for low-risk singleton deliveries.MethodsWe identified elective CS deliveries between 1st April 2000 and 28th February 2009 in English NHS trusts using the Hospital Episode Statistics. We selected women with uncomplicated pregnancies who had an elective CS delivery after 34 completed weeks of gestation, and analysed the trends and the trust-level variation in the timing of elective CS. The impact of the NICE guidance on the monthly rate of elective CS deliveries performed after 39 weeks was estimated using an interrupted time-series design with autoregressive integrated moving average (ARIMA).ResultsThere were 118,456 elective CS deliveries at the 63 NHS trusts. The overall proportion of elective CS deliveries done after 39 completed weeks steadily increased from 39% in 2000/01 to 63% in 2008/09. The proportions rose from 43% to 67% for women with breech presentation and from 35% to 62% for women with a previous CS. There was significant variation across NHS trusts in each year; in 2008/09, with the proportions of elective CS done after 39 weeks ranging from 28% to 89% (Inter-quartile range limits: 54% to 72%). We found a small but statistically significant increase in the proportion immediately after the publication of the NICE guidance, but its rate of growth rate declined slightly thereafter.ConclusionsNHS trusts in our study have responded to the new evidence on the benefits of delaying elective CS to after 39 weeks gestation. However, substantial differences between NHS trusts remain, which indicates there is room for further improvement. We suggest that maternity services and commissioners adopt the "timing of elective caesarean" as a quality indicator to support clinical practice.

Estimation of fetal oxygen uptake in human term pregnancies

Objective. Umbilical oxygen (O2) uptake is a parameter of basic physiologic interest. It has been extensively studied in chronically catheterized animals but very few data have been obtained acutely in humans. Recent developments in ultrasound technology allow the estimation of umbilical venous blood flow in utero.Methods. In all, 26 normal term pregnancies were studied at the time of elective cesarean section in order to evaluate fetal O2 uptake as the product of umbilical blood flow and umbilical O2 veno-arterial difference. An ultrasound evaluation was performed within 1 h from delivery: umbilical vein area and flow velocity were recorded to calculate umbilical vein volume flow (Qumb). Blood samples from the umbilical vein (uv) and artery (ua) were obtained at the time of fetal extraction for respiratory gases and acid–base evaluation.Results. Umbilical O2 uptake was calculated as Qumb • (uv-ua)O2 content: an average value of 0.84 ± 0.40 mmol/min was obtained. Umbilical O2 uptake per kg was 0.25 ± 0.12 mmol/kg/min, significantly related to fetal O2 delivery.Conclusions. We estimated umbilical blood flow by ultrasound and we measured umbilical O2 uptake at term obtaining a value of umbilical O2 uptake/kg similar to what previously reported in human pregnancies and chronically catheterized animals.