Evaluation of the results of emergency and elective cesarean deliveries performed in our hospital in the last year

Öz

Aim: The aim of this study is to investigate whether there is a difference between cesarean sections performed under emergency and elective conditions in terms of obstetric-fetal outcomes and complications. In the elective cesarean section group, 221 patients whose cesarean section was planned by the patient and the clinician were included, while 238 patients whose cesarean section was unplanned and emergency cesarean section was performed in the emergency cesarean section group. The data was obtained by retrospective file scanning. Age, week of birth, birth weight, indication for cesarean section, laboratory findings, maternal and perinatal complications and number of hospitalizations in the neonatal intensive care unit (NICU) were compared between the two groups. Materials and Methods: Our study included 459 patients who had a cesarean section in Erzincan Binali Yıldırım University Gynecology and Obstetrics Clinic between January 1, 2020 and March 31, 2021. Results: In the elective cesarean section group the most common indication for cesarean section was previous cesarean section (85.5%), while the most common indications in the emergency cesarean section group were previous cesarean section (27.3%) and fetal distress (23.9%). While 16 patients (7.2%) who received insufficient antenatal care in the elective cesarean section group, this number was 40 (16.9%) in the emergency cesarean section(p=0,03). 5th minute apgar score below 7, hospitalization in the NICU for more than 24 hours, and meconium amnion were observed more frequently in the emergency cesarean section group (p<0.05). In the emergency cesarean section group, the number of patients who received blood transfusion, the number of patients with wound infection, the number of patients with post-op fever, and the post-op hospital stay after cesarean section were higher than in the elective cesarean section group (Table 3)(p<0.05) Conclusion: As a result; Emergency cesarean delivery is associated with significantly higher maternal and fetal complications than elective cesarean deliveries. In cases where cesarean delivery is necessary, emergency cesarean section and related maternal-fetal complications can be reduced with the right timing and planning.

Anahtar Kelimeler

• Emergency cesarean section
• elective cesarean section
• maternal-fetal outcomes

Hastanemizde son bir yıl içerisinde yapılan acil ve elektif sezaryen doğum sonuçlarının değerlendirilmesi

Öz

Amaç: Acil ve elektif şartlarda yapılan sezaryenler arasında obstetrik-fetal sonuçlar ve komplikasyonlar açısından fark olup olmadığını araştırmaktır. Gereç ve Yöntemler: Çalışmamıza 1 Ocak 2020-31 Mart 2021 tarihleri arasında Erzincan Binali Yıldırım Üniversitesi Kadın Hastalıkları ve Doğum Kliniğinde sezaryen doğum yapan 459 hasta dahil edildi. Elektif sezaryen grubuna, hasta ve doğum ekibince sezaryen tarihi önceden planlanmış 221, acil sezaryen grubuna ise sezaryeni planlanmadan acil alınan 238 hasta dahil edildi. Hasta bilgilerine retrospektif dosya taraması yapılarak ulaşıldı. İki grup arasında yaş, doğum haftası, doğum kilosu, sezaryen endikasyonu, laboratuvar bulguları, maternal ve perinatal komplikasyonlar ve yenidoğan yoğun bakım ünitesine(YYBÜ) yatış sayıları karşılaştırıldı. Bulgular: Elektif sezaryen grubunda en sık sezaryen endikasyonu geçirilmiş sezaryen (%85,5) iken acil sezaryen grubunda en sık endikasyonlar geçirilmiş sezaryen (%27,3) ve fetal distressti (%23,9). Elektif sezaryen grubunda yetersiz antenatal bakım alan hasta 16 (%7,2) iken, acil sezaryen grubunda bu sayı 40 (%16,9)’dı ve fark istatistiksel olarak anlamlıydı (p=0,03). 5’inci dakika apgar skorunun 7’nin altında olması, YYBÜ’nde 24 saatten fazla yatış ve mekonyumlu amniyon mayi görülmesi acil sezaryen grubunda daha fazla izlendi (p<0,05). Acil sezaryen grubunda kan transfüzyonu yapılan, yara yeri enfeksiyonu olan, post-op ateş görülen hasta sayısı ve post-op hastanede yatış süresi elektif sezaryen grubuna göre daha fazla idi (Tablo 3) (p<0,05). Sonuç: Sonuç olarak; acil sezaryen doğum, elektif sezaryen doğumlara göre anlamlı derecede daha yüksek maternal ve fetal komplikasyonlarla ilişkilidir. Sezaryen doğumun gerekli olduğu durumlarda doğru zamanlama ve planlama ile acil sezaryen ve ona bağlı maternal fetal komplikasyonlar azaltılabilir.

Anahtar Kelimeler

• Acil sezaryen
• elektif sezaryen
• maternal-fetal sonuçlar

Kaynakça

1. World Health Organization. Pregnancy, Childbirth, Postpartum and Newborn Care: A Guide for Essential Practice. Geneva: WHO; 2006.
2. Vogel JP, Betrán AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J, et al. WHO Multi-Country Survey on Maternal and Newborn Health Research Network. 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 May;3(5):e260-70. doi: 10.1016/S2214-109X(15)70094-X.
3. Villar J, Carroli G, Zavaleta N, Donner A, Wojdyla D, Faundes A, et al. World Health Organization 2005 Global Survey on Maternal and Perinatal Health Research Group. Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ. 2007 Nov 17;335(7628):1025. doi: 10.1136/bmj.39363.706956.55.
4. Henderson J, McCandlish R, Kumiega L, Petrou S. Systematic review of economic aspects of alternative modes of delivery. BJOG. 2001 Feb;108(2):149-57. doi: 10.1111/j.1471-0528.2001.00044.
5. World Health Organization. Appropriate technology for birth. Lancet Glob Health. 1985;2(8452):436-7.
6. Thakur V, Chiheriya H, Thakur A, Mourya S. Study of maternal and fetal outcome in elective and emergency caesarean section. IJMRR. 2015;3(11):1300-5. doi: 10.17511/IJMRR.2015.I11.
7. Benzouina S, Boubkraoui Mel-M, Mrabet M, Chahid N, Kharbach A, El-Hassani A, et al. Fetal outcome in emergency versus elective cesarean sections at Souissi Maternity Hospital, Rabat, Morocco. Pan Afr Med J. 2016 Apr 15;23:197. doi: 10.11604/pamj.2016.23.197.7401.
8. Ghazi A, Karim F, Hussain AM, Ali T, Jabbar S. Maternal morbidity in emergency versus elective cesarean section at tertiary care hospital. J Ayub Med Coll Abbottabad. 2012;24(1):11-13.

9. Darnal N, Dangal G. Maternal and Fetal Outcome in Emergency versus Elective Caesarean Section. J Nepal Health Res Counc. 2020 Sep 7;18(2):186-189. doi: 10.33314/jnhrc.v18i2.2093.
10. American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for perinatal care. 5th ed. Elk Grove Village, Ill.: American Academy of Pediatrics, and Washington, D.C.: American College of Obstetricians and Gynecologists, 2002.
11. T.C. Sağlık Bakanlığı. Ana Çocuk Sağlığı ve Aile Planlaması Genel Müdürlüğü. Doğum Öncesi Bakım Yönetim Rehberi. Ankara, Türkiye, 2009.
12. Raatikainen K, Heiskanen N, Heinonen S. Under‐attending free antenatal care is associated with adverse pregnancy outcomes. BMC Public Health 2007;7:268.
13. Till SR, Everetts D, Haas DM. Incentives for increasing prenatal care use by women in order to improve maternal and neonatal outcomes. Cochrane Database Syst Rev. 2015 Dec 15;(12):CD009916. doi: 10.1002/14651858.CD009916.
14. Suwal A, Shrivastava VR, Giri A. Maternal and fetal outcome in elective versus emergency cesarean section. JNMA J Nepal Med Assoc. 2013 Oct-Dec;52(192):563-6. PMID: 25327227.
15. Elvedi-Gasparović V, Klepac-Pulanić T, Peter B. Maternal and fetal outcome in elective versus emergency caesarean section in a developing country. Coll Antropol. 2006 Mar;30(1):113-8. PMID: 16617584.
16. Anuwutnavin S, Kitnithee B, Chanprapaph P, Heamar S, Rongdech P. Comparison of maternal and perinatal morbidity between elective and emergency caesarean section in singleton-term breech presentation. J Obstet Gynaecol. 2020 May;40(4):500-506. doi: 10.1080/01443615.2019.1634018.
17. Najam R, Sharma R. Maternal and fetal outcomes in elective and emergency caesarean sections at a teaching hospital in North India: A retrospective study. JARBS. 2013;5(1):5- 9.
18. Cebekulu L, Buchmann EJ. Complications associated with cesarean section in the second stage of labor. Int J Gynaecol Obstet. 2006 Nov;95(2):110-4. doi: 10.1016/j.ijgo.2006.06.026.
19. Raees M, Yasmeen S, Jabeen S, Utman N, Karim R. Maternal morbidity associated with emergency versus elective caesarean section. J Postgrad Med Inst 2012; 27(1): 55-62.
20. Onankpa B, Ekele B. Fetal outcome following cesarean section in a university teaching hospital. J Natl Med Assoc. 2009 Jun;101(6):578-81. doi: 10.1016/s0027-9684(15)30943-3.
21. Miller M, Leader LR. Vaginal delivery after caesarean section. Aust N Z J Obstet Gynaecol. 1992 Aug;32(3):213-6. doi: 10.1111/j.1479-828x.1992.tb01949.x.
22. Nakashima J, Yamanouchi S, Sekiya S, Hirabayashi M, Mine K, Ohashi A, et al. Elective Cesarean section at 37 weeks is associated with the higher risk of neonatal complications. Tohoku J Exp Med. 2014 Aug;233(4):243-8. doi: 10.1620/tjem.233.243.