Rahman Sundus, Ullah Mohib, Ali Asma, Afridi Nighat, Bashir Humaira, Amjad Zahra, Jafri Aliya, Jawaid Areeba
Department of Obstetrics and Gynecology, Combined Military Hospital (CMH), Peshawar, PAK.
Department of Medicine, Islamabad International Hospital and Research Centre, Islamabad, PAK.
Cureus. 2022 Aug 2;14(8):e27607. doi: 10.7759/cureus.27607. eCollection 2022 Aug.
Introduction Neonatal mortality is a major challenge in low-middle-income countries. The current study was conducted to assess the association between preterm cesarean delivery and fetal outcomes. Methods A prospective study was conducted at the Combined Military Hospital in Peshawar, Pakistan, from October 1, 2020, to March 31, 2021. All women reporting to the hospital with a cephalic presentation and singleton pregnancies between the 27th and 34th weeks of gestation were included in the study. Pregnancies with an abnormal presentation, those diagnosed with a congenital abnormality, and those with indications for growth restriction or preterm delivery were excluded from the study. We also excluded infants delivered via vacuum or forceps. The outcomes of interest in this study included neonatal death prior to discharge, neonatal respiratory distress, sepsis, intraventricular hemorrhage (IVH), seizure, subdural hemorrhage (SDH), or appearance, pulse, grimace, activity, and respiration (APGAR) test score of less than 7 at five minutes. Maternal features including diabetes, hypertension and gestational age of delivery, parity, previous cesarean sections (CS), and last pregnancy outcomes were documented in a predefined pro forma. Results Our sample size consisted of 288 women, who were classified into two groups. Group A comprised 144 women who gave birth vaginally and group B consisted of 144 women who underwent CS. It was observed that women who underwent cesareans had a higher likelihood of a history of hypertension and related pathologies. It was also observed that these women had a greater likelihood of being of higher age compared to women who underwent vaginal deliveries. Neonates of women who had CS were at a greater risk of presenting with respiratory distress than those who had spontaneous vaginal deliveries. Conclusion Based on our findings, respiratory distress was significantly more common in babies of women who delivered via CS. However, there was no difference in neonatal outcomes in terms of IVH, seizures, SDH, and APGAR score of <7.
引言
新生儿死亡率是中低收入国家面临的一项重大挑战。本研究旨在评估早产剖宫产与胎儿结局之间的关联。
方法
2020年10月1日至2021年3月31日，在巴基斯坦白沙瓦的联合军事医院进行了一项前瞻性研究。纳入所有妊娠27至34周、头先露且单胎妊娠并到该医院就诊的妇女。研究排除了胎位异常、诊断为先天性异常以及有生长受限或早产指征的妊娠。我们还排除了通过真空吸引或产钳分娩的婴儿。本研究关注的结局包括出院前新生儿死亡、新生儿呼吸窘迫、败血症、脑室内出血（IVH）、癫痫发作、硬膜下出血（SDH）或5分钟时外观、脉搏、 grimace、活动和呼吸（APGAR）测试评分低于7分。产妇特征包括糖尿病、高血压、分娩孕周、产次、既往剖宫产史以及上次妊娠结局，均记录在预先定义的表格中。
结果
我们的样本包括288名妇女，分为两组。A组包括144名经阴道分娩的妇女，B组包括144名接受剖宫产的妇女。观察发现，接受剖宫产的妇女有高血压病史及相关病理情况的可能性更高。还观察到，与经阴道分娩的妇女相比，这些妇女年龄较大的可能性更大。剖宫产妇女的新生儿出现呼吸窘迫的风险高于自然阴道分娩的妇女。
结论
根据我们的研究结果，剖宫产妇女所生婴儿出现呼吸窘迫的情况明显更为常见。然而，在IVH、癫痫发作、SDH以及APGAR评分<7方面，新生儿结局并无差异。
