COMPARISON OF MATERNAL AND FETAL OUTCOMES IN EMERGENCY AND ELECTIVE CESAREAN SECTIONS: A RETROSPECTIVE STUDY

Öz

OBJECTIVE: Emergency cesarean section is a high-risk operation which is associated with morbidity and even mortality. This study has been designed to compare elective and emergency cesarean deliveries in aspect of maternal and neonatal outcomes. MATERIAL AND METHODS: This is a retrospective cross-sectional review of 1337 women who had a live birth by cesarean section at term during a six-month-long period. Two groups were determined: emergency and elective. Women were compared in terms of age, parity, cesarean indications, cesarean complications, and blood transfusion needs. Newborns were compared in terms of APGAR score at first and fifth minute, birth weights, and neonatal intensive care needs. RESULTS: There were 297 emergency (22.2%) and 1040 planned (77.8%) cesarean sections over the study period. The women who delivered by emergency cesarean section had significantly younger ages and lower gravidity and parity (p=0.001, p=0.023 and p=0.001, respectively). Fetal distress and umbilical cord prolapsus were significantly more frequent, while previous cesarean section and cephalopelvic disproportion were significantly less frequent in women who delivered by emergency cesarean delivery (p=0.001 for all). The need for transfusion, bladder injury, and wound infection was significantly higher in women who underwent emergency cesarean delivery (p=0.001, p=0.001 and p=0.014 respectively). The neonates delivered by emergency cesarean section had significantly lower birth weight and APGAR score at the first minute but a significantly higher need for an intensive care unit (p=0.002, p=0.009 and p=0.001, respectively). CONCLUSIONS: Emergency cesareans increase maternal and neonatal complications. That is why , elective cesarean section should be performed as early as possible to avoid the onset of spontaneous labor which would require emergency cesarean delivery.

Anahtar Kelimeler

• Cesarean Section
• Emergency
• Elective
• Fetal
• Maternal.

ACİL VE ELEKTİF SEZARYEN AMELİYATLARINDA MATERNAL VE NEONATAL SONUÇLARIN KARŞILAŞTIRILMASI: RETROSPEKTİF BİR ÇALIŞMA

Öz

AMAÇ: Acil sezaryen, morbidite ve hatta mortalite ile ilişkili, yüksek riskli bir ameliyattır. Bu çalışma, elektif ve acil sezaryen doğumlarını anne ve yenidoğan sonuçları açısından karşılaştırmak amacıyla tasarlandı. GEREÇ VE YÖNTEM: Bu, altı aylık bir süre boyunca miadında sezaryen ile canlı doğum yapan 1337 kadının kesitsel retrospektif bir incelemesidir. Acil ve elektif olarak iki gruba ayrıldı. Kadınların yaş, parite, sezaryen endikasyonları, sezaryen komplikasyonları ve kan transfüzyon ihtiyaçları karşılaştırıldı. Yenidoğanlar ise birinci ve beşinci dakika APGAR skorları, doğum ağırlıkları ve yenidoğan yoğum bakım ihtiyacı açısından karşılaştırıldı. BULGULAR: Çalışma süresi boyunca 297 acil (%22,2) ve 1040 planlı (%77,8) sezaryenle doğum gerçekleşti. Acil sezaryen ile doğum yapan kadınların yaşı, gravidası ve paritesi anlamlı olarak daha azdı (sırasıyla p=0,001, p=0,023 ve p=0,001). Acil sezaryenle doğum yapan kadınlarda fetal distres ve kordon sarkması anlamlı olarak daha sık görülürken, daha önce sezaryen geçirmiş olma ve baş-pelvis uyumsuzluğu anlamlı olarak daha azdı (tümü için p=0,001). Acil sezaryen yapılan kadınlarda transfüzyon ihtiyacı, mesane yaralanması ve yara yeri enfeksiyonu anlamlı olarak daha yüksekti (sırasıyla p=0,001, p=0,001 ve p=0,014). Acil sezaryenle doğurtulan yenidoğanların doğum ağırlığı ve birinci dakika APGAR skoru anlamlı derecede düşük, yoğun bakım ihtiyacı ise anlamlı derecede yüksekti (sırasıyla p=0,002, p=0,009 ve p=0,001). SONUÇ: Acil sezaryenler maternal ve yenidoğan komplikasyonlarını arttırmaktadır. Bu nedenle acil sezaryen gerektirecek durumlar mümkün olduğunca öngörülmeli ve spontan doğum eylemi başlamadan mümkün olduğunca erken yapılmalıdır.

Anahtar Kelimeler

• Sezaryen
• Acil
• Elektif
• Fetal
• Maternal

Kaynakça

1. 1. Carbone L, Saccone G, Conforti A, et al. Cesarean delivery: an evidence-based review of the technique. Minerva Obstet Gynecol. 2021;73(1):57-66.
2. 2. Sung S, Mahdy H. Cesarean Section. 2023 Jul 9. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. PMID: 31536313.
3. 3. Antoine C, Young BK. Cesarean section one hundred years 1920-2020: the Good, the Bad and the Ugly. J Perinat Med. 2020;49(1):5-16.
4. 4. Morton R, Burton AE, Kumar P, et al. Cesarean delivery: Trend in indications over three decades within a major city hospital network. Acta Obstet Gynecol Scand. 2020;99(7):909-16.
5. 5. Jenabi E, Khazaei S, Bashirian S, et al. Reasons for elective cesarean section on maternal request: a systematic review. J Matern Fetal Neonatal Med. 2020;33(22):3867-72.
6. 6. Gosset M, Ilenko A, Bouyou J, Renevier B. Emergency caesarean section. J Visc Surg. 2017;154(1):47-50.
7. 7. Prior CH, Burlinson CEG, Chau A. Emergencies in obstetric anaesthesia: a narrative review. Anaesthesia. 2022;77(12):1416-29.
8. 8. Caesarean birth. London: National Institute for Health and Care Excellence (NICE); 2024 Jan 30. PMID: 33877751.

9. 9. Jeppesen MM, Thygesen LC, Ekeloef S, et al. A nationwide cohort study of short- and long-term outcomes following emergency laparotomy. Dan Med J. 2019;66(1):A5523.
10. 10. Ylimartimo AT, Nurkkala J, Koskela M, et al. Postoperative Complications and Outcome After Emergency Laparotomy: A Retrospective Study. World J Surg. 2023;47(1): 119-29.
11. 11. Tolstrup MB, Watt SK, Gögenur I. Morbidity and mortality rates after emergency abdominal surgery: an analysis of 4346 patients scheduled for emergency laparotomy or laparoscopy. Langenbecks Arch Surg. 2017;402(4):615-23.
12. 12. Sharoky CE, Bailey EA, Sellers MM, et al. Outcomes of hospitalized patients undergoing emergency general surgery remote from admission. Surgery. 2017;162(3):612-9.
13. 13. Benzouina S, Boubkraoui Mel-M, et al. Fetal outcome in emergency versus elective cesarean sections at Souissi Maternity Hospital, Rabat, Morocco. Pan Afr Med J. 2016;(15)23:197.
14. 14. Vogel JP, Betrán AP, Vindevoghel N, 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;3(5): e260-70.
15. 15. American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice, Society for Maternal-Fetal Medicine. Medically Indicated Late-Preterm and Early-Term Deliveries: ACOG Committee Opinion, Number 831. Obstet Gynecol. 2021;138(1): e35-e39.
16. 16. Pallasmaa N, Ekblad U, Aitokallio-Tallberg A, et al. Cesarean delivery in Finland: maternal complications and obstetric risk factors. Acta Obstet Gynecol Scand. 2010;89(7): 896-902.
17. 17. Onankpa B, Ekele B. Fetal outcome following cesarean section in a university teaching hospital. J Natl Med Assoc. 2009;101(6): 578-81.
18. 18. 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;30(1):113-8.
19. 19. McCarthy FP, Rigg L, Cady L, et al. A new way of looking at Caesarean section births. Aust N Z J Obstet Gynaecol. 2007;47(4):316-20.
20. 20. Al Nuaim L, Soltan MH, Khashoggi T, et al. Outcome in elective and emergency cesarean sections: A comparative study. Ann Saudi Med. 1996;16(6):645-9.
21. 21. Danieli-Gruber S, Shalev-Rosenthal Y, Matot R, et al. Risks of urgent cesarean delivery preceding the planned schedule: A retrospective cohort study. PLoS One.2023;18(8): e0289655.
22. 22. Timofeev J, Reddy UM, Huang CC, Driggers RW, Landy HJ, Laughon SK. Obstetric complications, neonatal morbidity, and indications for cesarean delivery by maternal age. Obstet Gynecol. 2013;122(6):1184-95.
23. 23. Boyle A, Reddy UM, Landy HJ, et al. Primary cesarean delivery in the United States. Obstet Gynecol. 2013;122(1):33-40.
24. 24. Armson BA. Is planned cesarean childbirth a safe alternative? CMAJ. 2007;176(4):475-6.
25. 25. Phipps MG, Watabe B, Clemons JL, et al. Risk factors for bladder injury during cesarean delivery. Obstet Gynecol. 2005;105(1):156-60.
26. 26. Declercq E, Barger M, Cabral HJ, et al. Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births. Obstet Gynecol. 2007;109(3):669-77.
27. 27. Yang XJ, Sun SS. Comparison of maternal and fetal complications in elective and emergency cesarean section: a systematic review and meta-analysis. Arch Gynecol Obstet. 2017;296(3): 503.