Katwa Nagaraja, Vasudeva Akhila, Lewis Leslie E S, Kumar Pratap
1Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal University, Manipal, Udupi District, Karnataka India.
2Department of Neonatology, Kasturba Medical College, Manipal University, Manipal, Udupi District, Karnataka India.
J Obstet Gynaecol India. 2018 Apr;68(2):104-110. doi: 10.1007/s13224-017-0995-2. Epub 2017 Apr 25.
Elective cesarean deliveries (ECD) are still performed prior to 39 weeks. This study aimed to identify risk of neonatal respiratory morbidity (NRM) following ECD near term, in a South Indian population. Specifically, study aimed to measure the additional healthcare burden due to large number of ECDs performed prior to 39 weeks, in this local population.
We analyzed NRM among 1329 deliveries (584 ECD and 745 spontaneous vaginal delivery, SVD) in a tertiary hospital over 2 years. Neonates were grouped into: A: 35-36 weeks, B: 37-38 weeks, and C: ≥39 weeks. NRM was compared between ECD versus SVD.
Majority (433/584) of ECDs were performed between 37 and 38 weeks. Overall, 32% received steroid prophylaxis. Of 1329 newborns, 18/584 (3.82%) in ECD and 6/745 (0.8%) in SVD group developed NRM ( value of 0.004, OR 3.9, CI 1.54-9.93). Need of respiratory support among ECD was 4.28% compared to 0.53% in SVD ( < 0.001, OR 8.28; CI 2.86-23.94). However, comparing neonates born by ECD between groups B Vs C; there was only a modest increase in NRM (2.07 vs 0.9%; 0.48, OR 2.3 with CI 0.29-18.4) and in need of respiratory support (2.54 vs 0.9%; 0.47, OR 2.84; CI 0.36-22.2).
NRM following early term ECD continues to be a healthcare burden in India. Interestingly in this South Indian population, early term ECDs caused only modest increase in NRM, and this ethnic variation requires further evaluation to determine ideal time for ECD in local population.
择期剖宫产（ECD）仍在孕39周前进行。本研究旨在确定印度南部人群近期择期剖宫产后新生儿呼吸疾病（NRM）的风险。具体而言，该研究旨在衡量在当地人群中，39周前大量进行择期剖宫产所带来的额外医疗负担。
我们分析了一家三级医院两年内1329例分娩（584例择期剖宫产和745例自然阴道分娩，SVD）中的新生儿呼吸疾病情况。新生儿被分为：A组：35 - 36周，B组：37 - 38周，C组：≥39周。比较择期剖宫产与自然阴道分娩的新生儿呼吸疾病情况。
大多数（433/584）择期剖宫产在37至38周之间进行。总体而言，32%接受了类固醇预防。在1329例新生儿中，择期剖宫产组有18/584（3.82%）发生新生儿呼吸疾病，自然阴道分娩组有6/745（0.8%）发生（P值为0.004，比值比3.9，可信区间1.54 - 9.93）。择期剖宫产组需要呼吸支持的比例为4.28%，而自然阴道分娩组为0.53%（P < 0.001，比值比8.28；可信区间2.86 - 23.94）。然而，比较B组和C组择期剖宫产出生的新生儿；新生儿呼吸疾病仅略有增加（2.07%对0.9%；P = 0.48，比值比2.3，可信区间0.29 - 18.4），需要呼吸支持的情况也是如此（2.54%对0.9%；P = 0.47，比值比2.84；可信区间0.36 - 22.2）。
印度早期限期择期剖宫产后的新生儿呼吸疾病仍然是一项医疗负担。有趣的是，在这个印度南部人群中，早期限期择期剖宫产仅导致新生儿呼吸疾病略有增加，这种种族差异需要进一步评估，以确定当地人群择期剖宫产的理想时间。
