Timing of Elective Repeat Cesareans Section: A Risk Factor for Acute Neonatal Respiratory Morbidity.  “A Hospital- Based Study”

A. Al-Awqati, Tala

	Timing of Elective Repeat Cesareans Section: A Risk Factor for Acute Neonatal Respiratory Morbidity. “A Hospital- Based Study”
IRAQI JOURNALOF COMMUNITY MEDICINE
Article 1, Volume 25, Issue 2, 2012, Pages 103-107
Author
Tala A. Al-Awqati
Abstract
Background: Respiratory morbidity as a result of failure to clear lung fluids is common and can be challenging for neonates delivered by elective repeated cesarean delivery without being exposed to labour. Aim: To study the impact that timing of elective repeated cesarean delivery at or near-term, following an uncomplicated and low risk pregnancy, has on the development of acute neonatal respiratory morbidity compared with infants born via spontaneous vaginal delivery, aiming to provide evidence that can aid obstetricians in planning and counseling for elective repeated cesarean section, ultimately improving neonatal respiratory outcome thus decreasing neonatal morbidity and mortality. Patients and Methods: We conducted a prospective observational study of a cohort of 616 infants of gestational ages from 36to40 completed weeks, born to women who have had a low risk and uncomplicated pregnancy, of which 214 were born by elective repeated cesarean delivery without prior labor compared to 402 born by spontaneous vaginal delivery. All deliveries took place at the Obstetrics and Gynecology department of Al Yarmouk Teaching Hospital, during the period of the study from the 1st of July 2008 to 31st of June 2009. The risk of developing acute respiratory morbidity, Respiratory distress syndrome (RDS) and Transient tachypnea of newborn (TTN), in both groups were studied. Infant parameters: neonatal outcome, gestational age, Weight, sex, length of hospital stay as well as maternal parameters: Age, parity and mode of delivery were all analyzed, exclusion criteria were set for both maternal and infant parameters. Results: Overall acute neonatal respiratory morbidity risk, including Transient tachypnea of the newborn and Respiratory distress syndrome, was significantly higher in infants born by elective repeated cesarean compared with vaginal delivery, (Relative risk (RR) =4.0005, 95%Confidence Interval (CI)=3.0309-5.2803, p<0.0001), The risk for developing Transient tachypnea in infants born by elective repeated cesarean section showed a fourfold increase compared to infants delivered vaginally, (RR=4.2389, 95%CI =3.1208-5.756, p<0.0001); similarly the risk for Respiratory distress syndrome was increased six fold (RR=6.8462.95%CI=3.0571-15.3315, p<0.0001). Respiratory morbidity rate increased from gestational age of 36 weeks to 38 weeks, no significant difference found at 39-40 weeks gestation. Multiple logistic regression analyses showed that gestational age was a significant factor effecting the development of respiratory morbidity (p=0.0000).Male newborns delivered via elective repeated cesarean were more at risk to develop respiratory distress than females, this difference was statistically not significant in infants delivered vaginally. Conclusion: In comparison with spontaneous vaginal birth, infants delivered by elective repeat cesarean at or near -term were at significantly increased risk to develop acute respiratory morbidity; this risk increased progressively with decreasing gestational age.

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