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Mino Y, Miyahara F, Miura M, Imamoto A, Fujii H, Moriwaki C, Yoshioka K, Namba N. Risk of Transient Tachypnea of the Newborn following Elective Cesarean Section Increases at a Gestational Age of 37 Weeks Compared to That at ≥ 38 Weeks Despite the Exclusion of Pre-Existing Risk Factors for Neonatal Respiratory Disorders. Yonago Acta Med 2024; 67:150-156. [PMID: 38803593 PMCID: PMC11128081 DOI: 10.33160/yam.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024]
Abstract
Background Elective cesarean sections (ECSs) for early-term pregnancies at 37 weeks of gestational age (GA) aim to reduce the risk of emergency cesarean sections due to the onset of labor or rupture of membranes. However, resultant increases in neonatal respiratory disorders, including transient tachypnea of the newborn (TTN) have been observed. However, few studies have elucidated the associated risk factors. Consequently, we aimed to determine whether differences existed in the clinical outcomes between neonates delivered via ECS at 37 weeks and those delivered at ≥ 38 weeks of GA. Methods A retrospective analysis was conducted on 259 neonates born via ECS at Tottori University Hospital, between January 2013 and December 2019, with birthweights ≥ 2500 g and GAs > 37 weeks. The neonates were categorized into two cohorts: births at 37 and at ≥ 38 weeks of GA (37-week and 38-week cohorts). The principal clinical outcomes included the appearance, pulse, grimace, activity, and respiration (Apgar) scores, need for positive-pressure ventilation, incidence of TTN, and length of hospital stay. Results No statistically significant differences were observed in the indications for ECS, sex, or birthweight between the two cohorts. The 37-week cohort exhibited a lower 1-min Apgar score than did the 38-week cohort, with no statistically significant differences between the two cohorts, at 5 min. Statistically significant differences were not observed in the need for positive-pressure ventilation during initial resuscitation or length of hospital stay for patients with TTN between the two cohorts. Notably, the 37-week cohort exhibited a significantly higher incidence of TTN than did the 38-week cohort. Conclusion ECSs at 37 weeks of GA exhibited an increased risk of TTN than ECSs at ≥ 38 weeks of GA. Strategic neonatal care and adequate preparation can mitigate this risk without affecting the length of hospital stay.
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Affiliation(s)
- Yoichi Mino
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Fumiko Miyahara
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Mazumi Miura
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Aya Imamoto
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Hiromi Fujii
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Chisaki Moriwaki
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Kazuki Yoshioka
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Noriyuki Namba
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
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Takahashi D, Fujino Y, Sato T, Kuramoto A, Kawakami S, Ito M, Goto K. Timing of Elective Cesarean Section and Neonatal Outcomes in Term Singleton Deliveries: A Single-Center Experience. Am J Perinatol 2023. [PMID: 37607591 DOI: 10.1055/a-2158-5619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
OBJECTIVE This study aimed to evaluate the timing of elective cesarean sections at 37 to 41 weeks from a tertiary hospital in Japan. The primary outcome was the rate of adverse neonatal outcomes, especially focusing on neonates delivered at 38 weeks of gestation. STUDY DESIGN The study population was drawn from singleton pregnancies delivered following planned cesarean birth at the Fukuda Hospital from 2012 to 2019. Information on deliveries was obtained from the hospital database, which contains clinical, administrative, laboratory, and operating room databases. RESULTS After excluding women with chronic conditions, maternal complications, indications for multiple births, or a neonate with an anomaly, 2,208 neonates remained in the analysis. Among adverse neonatal outcomes, the rate was significantly higher in neonates delivered at 37 weeks of gestation (unadjusted odds ratio [OR] = 13.22 [95% confidence interval [CI]: 6.28, 27.86], p < 0.001) or 38 weeks of gestation (unadjusted OR = 1.82 [95% CI: 1.04, 3.19], p = 0.036) compared with neonates delivered at 39 to 41 weeks. The adjusted risk of any adverse outcome was significantly higher at 380-1/7 weeks (adjusted OR = 2.40 [95% CI: 1.35, 4.30], p = 0.003) and 382-3/7 weeks (adjusted OR = 1.89 [95% CI: 1.04, 3.44], p = 0.038) compared with neonates delivered at 39 to 41 weeks, respectively. CONCLUSION Our findings suggest that elective cesarean sections might be best scheduled at 39 weeks or later. When considering a cesarean at 38 weeks, it appears that 384/7 weeks of gestation or later could be a preferable timing in the context of reducing neonatal risks. However, as the composite outcome includes mostly minor conditions, the clinical significance of this finding needs to be carefully interpreted. KEY POINTS · Timing of elective cesarean sections from 37 to 41 weeks was evaluated in a Japanese tertiary hospital.. · Neonates delivered at 37 and 38 weeks had higher adverse outcome rates compared with 39 to 41 weeks.. · Scheduling elective cesarean sections at least 384/7 weeks or later may reduce neonatal risk..
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Affiliation(s)
- Daijiro Takahashi
- Division of Neonatology, Fukuda Hospital, Kumamoto, Japan
- Division of Pediatrics, Fukuda Hospital, Kumamoto, Japan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Tomoki Sato
- Division of Obstetrics and Gynecology, Fukuda Hospital, Kumamoto, Japan
| | - Akitaka Kuramoto
- Division of Obstetrics and Gynecology, Fukuda Hospital, Kumamoto, Japan
| | - Shoichi Kawakami
- Division of Obstetrics and Gynecology, Fukuda Hospital, Kumamoto, Japan
| | - Masaharu Ito
- Division of Obstetrics and Gynecology, Fukuda Hospital, Kumamoto, Japan
| | - Kei Goto
- Division of Pediatrics, Fukuda Hospital, Kumamoto, Japan
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Hoshino M, Shinozaki H, Kitahara Y, Kameda T, Hayashi K, Ogawa S, Itoh M, Iwase A. Optimal timing of elective repeat cesarean deliveries of term singleton pregnancies: A multicenter cross-sectional study. Taiwan J Obstet Gynecol 2022; 61:317-322. [PMID: 35361394 DOI: 10.1016/j.tjog.2022.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Cesarean deliveries must be optimally timed to minimize their effects on mothers and neonates. This study aimed to determine the optimal timing of elective repeat cesarean deliveries to reduce the incidence of neonatal respiratory disorders and of emergent cesarean deliveries. MATERIALS AND METHODS This multi-center, cross-sectional, retrospective analysis evaluated data on the maternal and neonatal outcomes of 856 singleton pregnancies scheduled for elective repeat cesarean deliveries at 37-39 weeks' gestation. The emergent cesarean delivery and neonatal respiratory disorder risks were analyzed according to the scheduled cesarean delivery times. RESULTS The elective cesarean delivery rates were 91.0% during the first and 92.6% during the second half of the 37th week of gestation, 88.7% during the first and 82.9% during the second half of the 38th week of gestation, and 62.5% during the first and 33.3% during the second half of the 39th week of gestation. The neonatal respiratory disorder rates were 21.8% for elective cesarean deliveries during the first half of the 37th week of gestation and approximately 8% for elective cesarean deliveries during the second half of the 37th week until the first half of the 38th week of gestation. No neonatal respiratory disorders occurred among the babies delivered by elective cesarean deliveries during the 39th week of gestation. CONCLUSION For improved maternal and neonatal outcomes in the Asian population, it may be better to perform scheduled elective repeat cesarean deliveries from the second half of the 37th week of gestation until the 38th week of gestation following confirmation of gestational age by early first trimester ultrasonography.
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Affiliation(s)
- Masamichi Hoshino
- Graduate School of Medicine, Gunma University, 3 Chome-39-22 Showamachi, Maebashi, Gunma, 371-8511, Japan; Iwajuku Clinic, 1506-3 Azami, Kasakakemachi, Midori, Gunma, 379-2311, Japan
| | - Hiromitsu Shinozaki
- Graduate School of Health Sciences, Gunma University, 3 Chome-39-22 Showamachi, Maebashi, Gunma, 371-8514, Japan.
| | - Yoshikazu Kitahara
- Graduate School of Medicine, Gunma University, 3 Chome-39-22 Showamachi, Maebashi, Gunma, 371-8511, Japan
| | - Takashi Kameda
- Graduate School of Medicine, Gunma University, 3 Chome-39-22 Showamachi, Maebashi, Gunma, 371-8511, Japan
| | - Kunihiko Hayashi
- Graduate School of Health Sciences, Gunma University, 3 Chome-39-22 Showamachi, Maebashi, Gunma, 371-8514, Japan
| | - Shota Ogawa
- Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masahiro Itoh
- Japan Community Health Care Organization, Gunma Chuo Hospital, 1 Chome-7-13 Kouncho, Maebashi, Gunma, 371-0025, Japan
| | - Akira Iwase
- Graduate School of Medicine, Gunma University, 3 Chome-39-22 Showamachi, Maebashi, Gunma, 371-8511, Japan
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Prediger B, Mathes T, Polus S, Glatt A, Bühn S, Schiermeier S, Neugebauer EAM, Pieper D. A systematic review and time-response meta-analysis of the optimal timing of elective caesarean sections for best maternal and neonatal health outcomes. BMC Pregnancy Childbirth 2020; 20:395. [PMID: 32641019 PMCID: PMC7341650 DOI: 10.1186/s12884-020-03036-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 05/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The 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. METHODS We 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. RESULTS We 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. CONCLUSION Our 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 REGISTRATION Registered in PROSPERO (CRD42017078231).
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Affiliation(s)
- Barbara Prediger
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Tim Mathes
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Stephanie Polus
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Angelina Glatt
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Stefanie Bühn
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Sven Schiermeier
- Department of Obstetrics and Gynecology, Witten/Herdecke University, Marien Hospital Witten, Marienplatz 2, 58452 Witten, Germany
| | - Edmund A. M. Neugebauer
- Brandenburg Medical School - Theodor Fontane, Faculty of Health, Campus Neuruppin, Fehrbelliner Str.38, 16816 Neuruppin, Germany
- Interdisciplinary Centre for Health Services Research, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
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Pirjani R, Afrakhteh M, Sepidarkish M, Nariman S, Shirazi M, Moini A, Hosseini L. 'Elective caesarean section at 38-39 weeks gestation compared to > 39 weeks on neonatal outcomes: a prospective cohort study. BMC Pregnancy Childbirth 2018; 18:140. [PMID: 29739452 PMCID: PMC5941590 DOI: 10.1186/s12884-018-1785-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 04/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background This study was conducted to compare neonatal complications in scheduled cesarean sections (CS) between 38 and 39 gestational weeks with CS performed after 39 gestational weeks in Iranian low -risk pregnant women. Methods In this cohort study, 2086 patients were enrolled based on the inclusion and exclusion criteria. The neonates were evaluated in terms of the following items: transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), sepsis, need for NICU hospitalization, birth weight, birth height, head circumference, and the first minute and fifth minute Apgar score. Several multiple logistic regression models were performed for each response variable (adverse outcome) separately. Results The incidence of NICU admission was significantly higher in neonates born at 38–39 gestational weeks than those who were born after 39 gestational weeks. No significant differences were found in the incidence of neonatal sepsis, TTN, and RDS between the two groups. Conclusion According to our study results, elective CS at 38–9 weeks’ gestation is associated with a higher rate of TTN and NICU admission in comparison with elective CS performed after 39 completed gestational weeks.
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Affiliation(s)
- Reihaneh Pirjani
- Obstetrics and Gynecology Department, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Research development center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahdi Sepidarkish
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Shahin Nariman
- Department of Pediatrics, Arash women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Shirazi
- Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashraf Moini
- Obstetrics and Gynecology Department, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR., Tehran, Iran
| | - Ladan Hosseini
- Research development center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Phaloprakarn C, Tangjitgamol S, Manusirivithaya S. Timing of elective cesarean delivery at term and its impact on maternal and neonatal outcomes among Thai and other Southeast Asian pregnant women. J Obstet Gynaecol Res 2016; 42:936-43. [PMID: 27079277 DOI: 10.1111/jog.13016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 02/01/2016] [Accepted: 02/26/2016] [Indexed: 12/01/2022]
Abstract
AIM The impact of timing of elective cesarean delivery (CD) at term on maternal and neonatal outcomes among Thai and other Southeast Asian pregnancies was investigated. The rate of spontaneous labor before the scheduled CD, as well as maternal characteristics predicting spontaneous labor, was also evaluated. METHODS Data on maternal and neonatal outcomes of 1221 singleton pregnancies scheduled for either an elective repeat CD or an elective primary CD at 37-40 weeks of gestation were studied. The association between maternal characteristics and the risk of spontaneous labor was evaluated by univariate and multivariate analyses. RESULTS There were no significant differences in severe maternal complications between performing an elective CD at 39 weeks and at the other gestational ages. Severe neonatal complications were significantly decreased when a CD was performed electively from 38 weeks onwards. A total of 503 women (41.2 %) went into spontaneous labor before the scheduled CD. Using 39 weeks as the reference group, scheduling a CD at 37 or 38 weeks decreased the risk of spontaneous labor (6.67-fold and 4.55-fold, respectively) while scheduling a CD at 40 weeks had a 2.54-fold increased risk. A history of previous CD and teenage pregnancy were also predictors of spontaneous labor; adjusted odds ratios were 14.27 and 3.93, respectively. CONCLUSION The timing of elective CD at term had impacts on pregnancy outcomes among Thai and other Southeast Asian women. Gestational age at scheduled CD, a previous CD and teenage pregnancy were predictors of spontaneous labor.
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Affiliation(s)
- Chadakarn Phaloprakarn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Siriwan Tangjitgamol
- Department of Obstetrics and Gynecology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Sumonmal Manusirivithaya
- Department of Obstetrics and Gynecology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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Terada K, Ito M, Kumasaka S, Suzuki S. Timing of elective cesarean singleton delivery and neonatal respiratory outcomes at a Japanese perinatal center. J NIPPON MED SCH 2015; 81:285-8. [PMID: 25186583 DOI: 10.1272/jnms.81.285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The present study examined the relation between the timing of elective cesarean delivery at term and neonatal respiratory outcomes at our institution. From 2005 through 2013, 1,951 elective cesarean singleton deliveries were performed at term. Of the neonates, 141 (7%) had respiratory disorders requiring oxygen supplementation. In comparison to the incidence of respiratory disorders in neonates delivered at full term (39-40 weeks), the incidences in neonates delivered at ≤38+1/7 weeks' and at 41 weeks' gestation were significantly higher. Uncomplicated elective cesarean singleton delivery should be avoided at 38+1 weeks or earlier, and we also pay attention to the respiratory outcomes of neonates delivered by elective cesarean section at 41 weeks' gestation.
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Affiliation(s)
- Kayoko Terada
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital
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Abstract
The current article covers some of the major themes that emerged in 2009 in the fields of obstetric anesthesiology, obstetrics, and perinatology, with a special emphasis on the implications for the obstetric anesthesiologist.
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Affiliation(s)
- J M Mhyre
- Department of Anesthesia, Division of Obstetric Anesthesia, Women's Hospital, University of Michigan Health System, Ann Arbor, MI 48109-5278, USA.
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Matsuo K, Shimoya K, Kimura T. Elective cesarean delivery at 38 weeks' gestation: is the timing too early? J Perinat Med 2010; 37:569. [PMID: 19492928 DOI: 10.1515/jpm.2009.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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