Timing of elective term deliveries and its association with adverse neonatal outcomes
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20230611Keywords:
APGAR score, Early term, Elective Delivery, Full term, Low birth weight, Neonate outcomeAbstract
Background: Pre and early term birth are one of the major causes of neonatal mortality and morbidity as compared to term infants. The risk of neonatal morbidity and mortality decreases with gestational age. Thus, this study aimed to determine the association of neonatal outcomes among early term and full-term elective deliveries.
Methods: A prospective cohort study was conducted at the department of obstetrics and gynecology, Aga Khan University Hospital, Pakistan. A total of 390 women, 195 in each study group were selected using a non-probability consecutive sampling. Demographic was presented as simple descriptive statistics giving mean and standard-deviation. Pearson’s chi-square and Fisher-Freeman-Halton exact test were used to compare qualitative data. Risk-ratios (RR) and confidence-intervals (CI) were calculated by using binary logistic regression. STATA V.17 SE software was used for data analysis.
Results: A total of 390 participants were recruited, including 195 patients in each group. The high prevalence of low Apgar score 5.6%, low birth weight 5.6% was found among early term when compared with full term. The respiratory distress was also reportedly high in early term neonates with 7.2%. Likewise, the prolonged hospital stays and NICU admissions were also more evident in early term elective deliveries i.e. 8.7% and 5.6%.
Conclusions: Early-term births are associated with adverse neonatal outcome of low APGAR score, low birth weight, hospital stay, NICU admission and respiratory distress when compared with neonates born as full term through elective deliveries. Similarly, the risk of prolonged hospital stay and NICU admissions were higher among the early term neonates.
References
SDGs. THE 17 GOALS. Sustainable Development. United Nations. United Nations. Available from: https://sdgs.un.org/goals. Accessed on 10 October 2022.
WHO. Sustainable Development Goal 3: Health. World Health Organization. World Health Organization; 2016. Available from: https://www.who.int/data/gho/data/themes/topics/sdg-target-3-1-maternal-mortality. Accessed on 10 October 2022.
Gülmezoglu AM, Lawrie TA, Hezelgrave N, Oladapo OT, Souza JP, Gielen M, et al. Interventions to Reduce Maternal and Newborn Morbidity and Mortality. In: Black RE, Laxminarayan R, Temmerman M, Walker N, eds. Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities. 3rd edn (Volume 2). Washington (DC): The International Bank for Reconstruction and Development /The World Bank; 2016.
WHO. Int. 2020. Maternal Mortality. Available from: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality. Accessed on 10 October 2022.
Nilses C, Nystrom L, Munjanja S, Lindmark G. Self-reported reproductive outcome and implications in relation to use of care in women in rural Zimbabwe. Acta Obstet Gynecol Scand. 2002;81:508-15.
Bhutta ZA, Hafeez A, Rizvi A, Ali N, Khan A, Ahmad F, et al. Reproductive, maternal, newborn, and child health in Pakistan: challenges and opportunities. Lancet. 2013; 381:2207-18.
Turab A, Pell LG, Bassani DG, Soofi S, Ariff S, Bhutta ZA, et al. The community-based delivery of an innovative neonatal kit to save newborn lives in rural Pakistan: design of a cluster randomized trial. BMC Pregnancy Childbirth. 2014;14:315.
World Health Organization. ICD-10: International statistical classification of diseases and related health problems, 10th revision. 2nd edn. Volume 2. Geneva: WHO; 2004.
Spong CY. Defining term pregnancy: recommendations from the defining term pregnancy workgroup. JAMA. 2013;309:2445-6.
Engle WA, Tomashek KM, Wallman C. Committee on Fetus and Newborn. “Late-preterm” infants: a population at risk. Pediatrics. 2007;120(6):1390-401.
Bailit JL, Gregory KD, Reddy UM, Gonzalez-Quintero VH, Hibbard JU, Ramirez MM, et al. Maternal and neonatal outcomes by labour onset type and gestational age. Am J Obstet Gynecol. 2010;202-45.
ACOG Practice Bulletin No. 107. Induction of labour. American College of Obstetricians and Gynecologists. Obstet Gynecol 2009;114(2 pt 1):386-97.
Sengupta S, Carrion V, Shelton J, Wynn RJ. Adverse neonatal outcomes associated with early-term birth JAMA Pediatr. 2013;167(11):1053-9.
Committee Opinion No. 561. Nonmedically indicated early-term deliveries. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2013;121(4 p):911-5.
Alan TN, Landon MB, Spong VY, Lai Y, Leveno KJ. Timing of elective repeat cesarean delivery at term and neonatal outcomes N Enl J Med. 2009;360(2):111-20.
Laughon SK, Reddy UM, Sun L, Zhang J. Precursors for late preterm birth in singleton gestations. Obstet Gynecol. 2010;116:1047-55.
Tita AT, Landon MB, Spong CY, Lai Y, Leveno KJ, Varner MW, et al. Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med. 2009;360(2):111-20.
Gray RF, Indurkhya A, McCormick MC. Prevalence, stability, and predictors of clinically significant behavior problems in low-birth-weight children at 3, 5, and 8 years of age. Pediatrics. 2004;114:736-43.
Huddy CL, Johnson A, Hope PL. Educational and behavioural problems in babies of 32-35 weeks gestation. Arch Dis Child Fet Neonat Ed. 2001;85:F23-8.
McCormick MC, Workman-Daniels K, Brooks-Gunn J. The behavioral and emotional wellbeing of school-age children with different birth weights. Pediatrics. 1996;97:18-25.
Oluwafemi RO, Adesina FP, Hassan AO. Outcomes and Disease Spectrum of LBW Neonates in a Secondary Health Facility. J Healthcare Eng. 2022;2022:9974636.
Phoya F, Langton J, Dube Q, Iroh Tam PY. Association of neonatal hypothermia with morbidity and mortality in a tertiary hospital in Malawi. J Trop Pediatr. 2020;66(5):470-8.
Ramprakash MA, Charanraj H, Manikumar S, Srinivasan K, Umadevi L, Giridhar S, et al. Neonatal outcomes in early term neonates versus term neonates in a tertiary care hospital - A cross sectional comparative study. Intern Arc Integ Med. 2016;3(4):21-6.
Qaisrani GH, Rizvi S, Jafri A, Haider R. Comparison of fetal outcome in planned elective deliveries at 38 and 39 gestational weeks at Lady Willingdon Hospital, Lahore. Ann King Ed Med Uni. 2016;21(4):285-9.
Sebastian G, Ghose S, Soundararajan P. Comparison of maternal and neonatal outcome in elective lower segment cesarean section done at 38 and 39 weeks. Intern J Reprod Contracept Obstet Gynecol. 2017;6(4):1604-9.
Parikh LI, Reddy UM, Männistö T, Mendola P, Sjaarda L, Hinkle S, et al. Neonatal outcomes in early term birth. Am J Obstet Gynecol. 2014;211(3):265-e1.
