Neonatal outcomes of elective caesarean section at term without prophylactic use of antenatal corticosteroids

Authors

  • Shazia Masheer Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan
  • Arzina Aziz Ali Department of Medicine, Indiana University Hospital Center, Indianapolis, Indiana, USA
  • Uswa Jiwani Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
  • Sakina Gheewala Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
  • Jehanzaeb Jang Department of Medicine, Medstar Washington Hospital Center, Washington DC, USA
  • Fariha Shaheen Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
  • Arjumand Rizvi Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
  • Pareesa Memon Medical College, Dr. Ziauddin University, Karachi, Pakistan
  • Shabina Ariff Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20231680

Keywords:

Antenatal care, Corticosteroids, Caesarean Section, Infant, New-born, Infant

Abstract

Background: We aimed to describe the outcomes of neonates born at or near term to women undergoing elective C-section without prophylactic corticosteroids.

Methods: Single-centre retrospective observational study of neonates born between 36+0 and 42+0 weeks. Associations between neonatal complications and maternal and neonatal factors were evaluated by univariate analyses and multivariate logistic regression.

Results: A total of 2151 (26%) neonates were born by elective C-section during the study period, of whom 429 were included in the study. Fifty-six (13.05%) neonates developed some complication with 39 (9.1%) requiring NICU admission. Respiratory distress syndrome (RDS) and hypoglycemia occurred in 21 (4.9%) and 7 (1.6%) neonates, respectively. Maternal age >35 was associated with higher odds of neonatal complications (OR: 5.52, 95% CI: 1.02-29.74, p=0.047).

Conclusions: The rate of RDS was comparable to other reported studies. The study revealed a high rate of term elective C-sections, providing grounds for conducting further research on administering antenatal corticosteroid to this population to reduce new-born morbidities.

 

References

Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PloS one. 2016;11(2):e0148343.

NIPS, ICF. Pakistan Demographic and Health Survey 2017-2018. Islamabad, Pakistan, and Rockville, Maryland, USA; National Institution of Population Study (NIPS) and ICF. 2019.

Gregory KD, Jackson S, Korst L, Fridman M. Cesarean versus vaginal delivery: whose risks? Whose benefits? Am J Perinatol. 2012;29(1):7-18.

Liu S, Liston RM, Joseph KS, Heaman M, Sauve R, Kramer MS; Maternal Health Study Group of the Canadian Perinatal Surveillance System. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ. 2007;176(4):455-60.

Tefera M, Assefa N, Mengistie B, Abrham A, Teji K, Worku T. Elective cesarean section on term pregnancies has a high risk for neonatal respiratory morbidity in developed countries: a systematic review and meta-analysis. Front Pediatr. 2020;8:286.

Maso G, Monasta L, Piccoli M, Ronfani L, Montico M, De Seta F et al. Risk-adjusted operative delivery rates and maternal-neonatal outcomes as measures of quality assessment in obstetric care: A multicenter prospective study. BMC Pregnancy Childbirth. 2015;15(1):20.

Ahimbisibwe A, Coughlin K, Eastabrook G. Respiratory Morbidity in Late Preterm and Term Babies Born by Elective Caesarean Section. J Obstet Gynaecol Can. 2019;41(8):1144-1149.

Fowden AL, Li J, Forhead AJ. Glucocorticoids and the preparation for life after birth: are there long-term consequences of the life insurance? Proc Nutr Soc. 1998;57(1):113-22.

Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2017;3(3):CD004454.

Committee on Obstetric Practice. Committee Opinion No. 713: Antenatal Corticosteroid Therapy for Fetal Maturation. Obstet Gynecol. 2017;130(2):e102-9.

National Institute for Health and Care Excellence. Preterm labour and birth. NICE guideline. NICE. Available at https:// www. nice. org. uk/ guidance/ng25?unlid=9291036072016213201257

Shanks AL, Grasch JL, Quinney SK, Haas DM. Controversies in antenatal corticosteroids. Semin Fetal Neonatal Med. 2019;24(3):182-188.

Vogel JP, Oladapo OT, Manu A, Gülmezoglu AM, Bahl R. New WHO recommendations to improve the outcomes of preterm birth. Lancet Glob Health. 2015;3(10):e589-90.

Stock SJ, Thomson AJ, Papworth S. Royal College of Obstetricians and Gynaecologists. Antenatal corticosteroids to reduce neonatal morbidity and mortality: Green-top Guideline No. 74 February 2022: Green-top Guideline No. BJOG. 2022;10:1471-528.

Crowther CA, Brown J, Alsweiler J, Middleton P. Antenatal corticosteroids given to women prior to birth to improve fetal, infant, child and adult health: Clinical Practice Guidelines. Liggins Institute. 2014.

Mortality and Acute Complications in Preterm Infants. In: Behrman RE, Butler AS (ed). Preterm Birth: Causes, Consequences, and Prevention. Washington (DC): National Academies Press (US); 2007. Available at https:// www. ncbi.nlm.nih.gov/books/NBK11385/. Accessed on 12 July 2023.

Gregory KE. New approaches to care of the infant with hypoglycemia. J Perinat Neonatal Nurs. 2016;34(4):284-7.

Ahimbisibwe A, Coughlin K, Eastabrook G. Respiratory Morbidity in Late Preterm and Term Babies Born by Elective Caesarean Section. J Obstet Gynaecol Can. 2019;41(8):1144-9.

Zanardo V, Simbi AK, Franzoi M, Soldà G, Salvadori A, Trevisanuto D. Neonatal respiratory morbidity risk and mode of delivery at term: influence of timing of elective caesarean delivery. Acta Paediatr. 2004;93(5):643-7.

Al Riyami N, Al Hadhrami A, Al Lawati T, Pillai S, Abdellatif M, Jaju S. Respiratory Distress Syndrome in Neonates Delivered at Term-gestation by Elective Cesarean Section at Tertiary Care Hospital in Oman. Oman Med J. 2020;35(3):e133.

Sotiriadis A, Makrydimas G, Papatheodorou S, Ioannidis JP, McGoldrick E. Corticosteroids for preventing neonatal respiratory morbidity after elective caesarean section at term. Cochrane Database Syst Rev. 2018;8:76-9.

Arruda A, Ormonde M, Stokreef S. Is there a role for antenatal corticosteroids in term infants before elective cesarean section? Rev Bras Ginecol Obstet. 2021;43(4):283-90.

WHO action trials collaborators. antenatal dexamethasone for early preterm birth in low-resource countries. N Engl J Med. 2020;383(26):2514-25.

McClure EM, Johnson J, Jobe AH, Wall S, Koblinsky M, Moran A, et al. A conference report on prenatal corticosteroid use in low- and middle-income countries. Int J Gynaecol Obstet. 2011;115(3):215-9.

Benova L, Macleod D, Footman K, Cavallaro F, Lynch CA, Campbell OM. Role of the private sector in childbirth care: cross-sectional survey evidence from 57 low- and middle-income countries using Demographic and Health Surveys. Trop Med Int Health. 2015;20(12):1657-73.

Villar J, Valladares E, Wojdyla D, Zavaleta N, Carroli G, Velazco A et al. Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. Lancet. 2006;367(9525):1819-29.

Vogel JP, Betrán AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J, et al. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Glob Health. 2015;3(5):e260-70.

Wilmink FA, Hukkelhoven CW, Lunshof S, Mol BW, van der Post JA, Papatsonis DN. Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: a 7-year retrospective analysis of a national registry. Am J Obstet Gynecol. 2010;202(3):250.e1-8.

Lean SC, Derricott H, Jones RL, Heazell AEP. Advanced maternal age and adverse pregnancy outcomes: A systematic review and meta-analysis. PLoS One. 2017;12(10):e0186287.

Kahveci B, Melekoglu R, Evruke IC, Cetin C. The effect of advanced maternal age on perinatal outcomes in nulliparous singleton pregnancies. BMC Pregnancy Childbirth. 2018;18(1):343.

Londero AP, Rossetti E, Pittini C, Cagnacci A, Driul L. Maternal age and the risk of adverse pregnancy outcomes: a retrospective cohort study. BMC Pregnancy Childbirth. 2019;19(1):261.

Sun H, Xu F, Xiong H, Kang W, Bai Q, Zhang Y et al. Characteristics of respiratory distress syndrome in infants of different gestational ages. Lung. 2013;191(4):425-33.

Thompson JA. The risks of advancing parental age on neonatal morbidity and mortality are U- or J-shaped for both maternal and paternal ages. BMC Pediatr. 2020;20(1):453.

Pinheiro RL, Areia AL, Mota Pinto A, Donato H. Advanced Maternal Age: Adverse Outcomes of Pregnancy, A Meta-Analysis. Acta Med Port. 2019;32(3):219-26.

Finn D, O'Neill SM, Collins A, Khashan AS, O'Donoghue K, Dempsey E. Neonatal outcomes following elective caesarean delivery at term: a hospital-based cohort study. J Matern Fetal Neonatal Med. 2016;29(6):904-10.

Khasawneh W, Obeidat N, Yusef D, Alsulaiman JW. The impact of cesarean section on neonatal outcomes at a university-based tertiary hospital in Jordan. BMC Pregnancy Childbirth. 2020;20(1):335.

Anadkat JS, Kuzniewicz MW, Chaudhari BP, Cole FS, Hamvas A. Increased risk for respiratory distress among white, male, late preterm and term infants. J Perinatol. 2012;32(10):780-5.

Liu J, Yang N, Liu Y. High-risk Factors of Respiratory Distress Syndrome in Term Neonates: A Retrospective Case-control Study. Balkan Med J. 2014;31(1):64-8.

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Published

2023-05-31

How to Cite

Masheer, S., Aziz Ali, A., Jiwani, U., Gheewala, S., Jang, J., Shaheen, F., Rizvi, A., Memon, P., & Ariff, S. (2023). Neonatal outcomes of elective caesarean section at term without prophylactic use of antenatal corticosteroids . International Journal Of Community Medicine And Public Health, 10(6), 2047–2053. https://doi.org/10.18203/2394-6040.ijcmph20231680

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Original Research Articles