scholarly journals Morbilidade Neonatal e Cesariana Electiva em Recém-Nascidos de Termo

2015 ◽  
Vol 28 (5) ◽  
pp. 601 ◽  
Author(s):  
Maria Cristina Resende ◽  
Lea Santos ◽  
Isabel Santos Silva
Keyword(s):  
Gestational Age ◽  
Odds Ratio ◽  
Neonatal Intensive Care ◽  
Neonatal Morbidity ◽  
Elective Cesarean Section ◽  
Respiratory Morbidity ◽  
Cesarean Sections ◽  
Feeding Difficulties ◽  
Elective Cesarean ◽  
Term Newborns

<strong>Introduction:</strong> International guidelines suggest that non-urgent planned deliveries be scheduled at or after 39 weeks. Despite this recommendation elective cesarean often occurs before 39 weeks. Some research has demonstrated that elective cesarean before 39 weeks poses a greater risk to the infants than at or after 39 weeks.<br /><strong>Objective:</strong> To evaluate neonatal morbidity in term newborns born by elective cesarean section.<br /><strong>Material and Methods:</strong> Retrospective study of all term elective cesarean sections (scheduled and without labor) performed in level III maternity, in the last 11 years (2003 - 2013). High risk pregnancies were excluded: twins, premature rupture of membranes, preeclampsia, poorly controlled diabetes mellitus, Rh isoimmunization and congenital malformations. Two groups of newborns with gestational age less than 39 weeks and equal or greater than 39 weeks gestational age were compared.<br /><strong>Results:</strong> In our sample, 45% of elective caesarean sections were performed before 39 weeks. Infants born before 39 weeks were more frequently admitted in neonatal intensive care, odds ratio 2.4 [1.4 – 4.1] p = 0.001, had more respiratory morbidity, odds ratio 2.4 [1.6 - 3.8] p &lt; 0.001, more hyperbilirubinaemia odds ratio 2.3 [1.5 – 3.7] p &lt; 0.001, more hypoglycaemia and/or feeding difficulties odds ratio 1.6 [1.2 – 2.4] p = 0.006, and longer admissions (more than five days), odds ratio 2.0 [1.4 - 3] p &lt; 0.001.<br /><strong>Discussion:</strong> As in other studies ‘early term’ had higher respiratory and metabolic morbidity and consequently had a longer hospital stay.<br /><strong>Conclusion:</strong> These findings support recommendations to delay elective cesarean delay until 39 weeks of gestation.

scholarly journals Is there a Role for Antenatal Corticosteroids in Term Infants before Elective Cesarean Section?

2021 ◽  
Vol 43 (04) ◽  
pp. 283-290
Author(s):  
Augusta Arruda ◽  
Mariana Ormonde ◽  
Sarah Stokreef ◽  
Beatriz Fraga ◽  
Catarina Franco ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Gestational Age ◽  
Statistical Significance ◽  
Neonatal Morbidity ◽  
Exposed Group ◽  
Neonatal Outcomes ◽  
Elective Cesarean Section ◽  
Respiratory Morbidity ◽  
Antenatal Corticosteroids ◽  
Term Infants

Abstract Objective Cesarean section (CS) delivery, especially without previous labor, is associated with worse neonatal respiratory outcomes. Some studies comparing neonatal outcomes between term infants exposed and not exposed to antenatal corticosteroids (ACS) before elective CS revealed that ACS appears to decrease the risk of respiratory distress syndrome (RDS), transient tachypnea of the neonate (TTN), admission to the neonatal intensive care unit (NICU), and the length of stay in the NICU. Methods The present retrospective cohort study aimed to compare neonatal outcomes in infants born trough term elective CS exposed and not exposed to ACS. Outcomes included neonatal morbidity at birth, neonatal respiratory morbidity, and general neonatal morbidity. Maternal demographic characteristics and obstetric data were analyzed as possible confounders. Results A total of 334 newborns met the inclusion criteria. One third of the population study (n = 129; 38.6%) received ACS. The present study found that the likelihood for RDS (odds ratio [OR] = 1.250; 95% confidence interval [CI]: 0.454–3.442), transient TTN (OR = 1.,623; 95%CI: 0.556–4.739), and NIUC admission (OR = 2.155; 95%CI: 0.474–9.788) was higher in the ACS exposed group, although with no statistical significance. When adjusting for gestational age and arterial hypertension, the likelihood for RDS (OR = 0,732; 95%CI: 0.240–2.232), TTN (OR = 0.959; 95%CI: 0.297–3.091), and NIUC admission (OR = 0,852; 95%CI: 0.161–4.520) become lower in the ACS exposed group. Conclusion Our findings highlight the known association between CS-related respiratory morbidity and gestational age, supporting recent guidelines that advocate postponing elective CSs until 39 weeks of gestational age.

Neonatal Morbidity of Monoamniotic Twin Pregnancies: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Danilo Buca ◽  
Daniele Di Mascio ◽  
Asma Khalil ◽  
Ganesh Acharya ◽  
Tim Van Mieghem ◽  
...  
Keyword(s):  
Gestational Age ◽  
Primary Outcome ◽  
Random Effect ◽  
Neonatal Morbidity ◽  
Small Sample ◽  
Respiratory Morbidity ◽  
Infectious Morbidity ◽  
Neurological Morbidity ◽  
Twin Pregnancies ◽  
Type Of Management

Objective This study was aimed to report the incidence of neonatal morbidity in monochorionic monoamniotic (MCMA) twin pregnancies according to gestational age at birth and type of management adopted (inpatient or outpatient). Study Design Medline and Embase databases were searched. Inclusion criteria were nonanomalous MCMA twins. The primary outcome was a composite score of neonatal morbidity, defined as the occurrence of at least one of the following outcomes: respiratory morbidity, overall neurological morbidity, severe neurological morbidity, and infectious morbidity, necrotizing enterocolitis at different gestational age windows (24–30, 31–32, 33–34, and 35–36 weeks). Secondary outcomes were the individual components of the primary outcome and admission to neonatal intensive care unit (NICU). Subanalysis according to the type of surveillance strategy (inpatient compared with outpatient) was also performed. Random effect meta-analyses were used to analyze the data. Results A total of 14 studies including 685 MCMA twin pregnancies without fetal anomalies were included. At 24 to 30, 31 to 32, 33 to 34, and 35 to 36 weeks of gestation, the rate of composite morbidity was 75.4, 65.5, 37.6, and 18.5%, respectively, the rate of respiratory morbidity was 74.2, 59.1, 35.5, and 12.2%, respectively, while overall neurological morbidity occurred in 15.3, 10.2, 4.3, and 0% of the cases, respectively. Infectious morbidity complicated 13, 4.2, 3.1, and 0% of newborns while 92.1, 81.6, 58.7, and 0% of cases required admission to NICU. Morbidity in pregnancies delivered between 35 and 36 weeks of gestation was affected by the very small sample size of cases included. When comparing the occurrence of overall morbidity according to the type of management (inpatient or outpatient), there was no difference between the two surveillance strategies (p = 0.114). Conclusion MCMA pregnancies are at high risk of composite neonatal morbidity, mainly respiratory morbidity that gradually decreases with increasing gestational age at delivery with a significant reduction for pregnancies delivered between 33 and 34 weeks. We found no difference in the occurrence of neonatal morbidity between pregnancies managed as inpatient or outpatient. Key Points

Report of a Case of Annular Pancreas of the Newborn in Two Consecutive Siblings

PEDIATRICS ◽  
1971 ◽  
Vol 48 (1) ◽  
pp. 148-150
Author(s):  
R. C. Montgomery ◽  
M. H. Poindexter ◽  
G. H. Hall ◽  
John E. Leigh
Keyword(s):  
Cesarean Section ◽  
Intestinal Obstruction ◽  
Duodenal Obstruction ◽  
Case Reports ◽  
Annular Pancreas ◽  
Elective Cesarean Section ◽  
Cesarean Sections ◽  
Elective Cesarean ◽  
Previous Cesarean ◽  
High Intestinal Obstruction

Annular pancreas presenting as high intestinal obstruction in the newborn has been reported on numerous occasions.14 The purpose of this paper is to report the occurrence of annular pancreas causing duodenal obstruction in the newborn in two consecutive siblings. Case Reports Case 1, D.B., a male, was born August 31, 1966. The mother was gravida III, para II. Her expected date of confinement was September 12, 1966. The pregnancy had been uneventful except that she had minimal polyhydramnios. The mother had been on no medications during her pregnancy except a prenatal vitamin and iron. On August 31, 1966 the mother underwent an elective cesarean section because of previous cesarean sections which were performed for cephalo-pelvic disproportion.

Oxygen saturation trends in normal healthy term newborns: normal vaginal delivery vs. elective cesarean section

2018 ◽  
Vol 46 (2) ◽  
pp. 191-195 ◽  
Author(s):  
Rashi Bhargava ◽  
Madhu Mathur ◽  
Jyoti Patodia
Keyword(s):  
Birth Weight ◽  
Cesarean Section ◽  
Oxygen Saturation ◽  
Vaginal Delivery ◽  
Neonatal Resuscitation ◽  
Elective Cesarean Section ◽  
Normal Vaginal Delivery ◽  
Elective Cesarean ◽  
Term Newborns ◽  
The Mean

AbstractObjectives:To study the normal oxygen saturation trends and fetomaternal correlates in healthy term newborns within 30 min of life born by normal vaginal delivery (NVD) and elective cesarean section (CS).Materials and methods::A cross-sectional study was conducted on 200 healthy term newborns born by NVD and elective CS at a tertiary care centre. Routine care as per the Neonatal Resuscitation Program (NRP) 2015 (Wyckoff MH, Aziz K, Escobedo MB, Kapadia VS, Kattwinkel J, Perlman JM, et al. Part 13: neonatal resuscitation: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132:S543–60) protocol was given and pre-ductal arterial oxygen saturation was assessed by pulse oximetry at different intervals after birth.Results:The mean peripheral oxygen saturation (SpO2) was 85.4%, 90.8%, 94.1%, 95.7%, 96.7% and 97.4% at 5, 10, 15, 20, 25 and 30 min, respectively, after birth. Higher mean SpO2was observed in NVD compared to elective CS (P<0.005). The mean time for SpO2to reach >90% was 9.13 min in NVD and 12.31 min in elective CS (P<0.001). Maternal hemoglobin (Hb) (r=−0.15; P<0.01), birth weight (r=−0.125; P<0.05) and Apgar at 10 min (r=0.33; P<0.001) were significantly correlated with SpO2of newborns at 10 min of life.Conclusion:Our study defines normal SpO2levels in healthy term newborns in the first 30 min of life born by NVD and elective CS. Babies born by NVD had significantly higher SpO2levels and attained SpO2>90% faster than those born by elective CS. Maternal Hb, birth weight and Apgar at 10 min were significant factors affecting SpO2levels of newborns at 10 min of life.

scholarly journals The association between birth by cesarean section and adolescent cardiorespiratory fitness in a cohort of 339,451 Swedish males

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Lucas D. Ekstrom ◽  
Viktor H. Ahlqvist ◽  
Margareta Persson ◽  
Cecilia Magnusson ◽  
Daniel Berglind
Keyword(s):  
Cesarean Section ◽  
Cardiorespiratory Fitness ◽  
Cycle Ergometer ◽  
Elective Cesarean Section ◽  
Cesarean Sections ◽  
Cycle Ergometer Test ◽  
Elective Cesarean ◽  
Birth Characteristics ◽  
Ergometer Test

Abstract Birth by cesarean section is increasing worldwide and associates with offspring morbidities capable of adversely impacting cardiorespiratory fitness later in life. Whether birth by cesarean section associates with lower levels of cardiorespiratory fitness later in life is unknown and is of interest to public health. Four Swedish national registers were linked to follow 339,451 singleton males, born between 1973–1987 until December 31 2005, for Watt-maximum achieved on a cycle ergometer test at conscription into the Swedish military. Main exposure was birth by cesarean section which was compared to vaginal birth. A sub-population of 45,999 males born between 1982–1987 was identified to explore differentiated associations between elective and non-elective cesarean section with Watt-maximum. Within-family analyses of 34,252 families with 70,632 biological male siblings, who conscripted during the study period, were performed to explore the role of familial confounding on Watt-maximum. Swedish males born by cesarean section achieved lower mean Watt-maximum (− 2.32 W, 95%C.I. − 2.90 to − 1.75) and displayed excess odds of low cardiorespiratory fitness (aOR = 1.08, 95%C.I. 1.05 to 1.11) at conscription in the eighteenth life-year compared to males born vaginally after adjusting for birth characteristics, maternal morbidities and parental socioeconomic position. In the sub-population, males born 1982–1987, there was a greater negative association of elective cesarean section with cardiorespiratory fitness (− 4.42 W, 95%C.I. − 6.27 to − 2.57, p < 0.001) than non-elective cesarean sections (− 1.96 W, 95%C.I. − 3.77 to − 0.16, p = 0.033) as compared to vaginal births. No associations between modes of cesarean delivery and cardiorespiratory fitness levels persisted in the within-family analyses where biological male siblings were compared whilst controlling for factors shared within families. Males born by cesarean section had lower levels of cardiorespiratory fitness eighteen years later compared to males born vaginally. These findings appear to be largely explained by factors of familial confounding.

scholarly journals Circulating levels of ghrelin in human fetuses

2003 ◽  
pp. 111-116 ◽  
Author(s):  
D Cortelazzi ◽  
V Cappiello ◽  
PS Morpurgo ◽  
S Ronzoni ◽  
MS Nobile De Santis ◽  
...  
Keyword(s):  
Gestational Age ◽  
Venous Blood ◽  
Elective Cesarean Section ◽  
Intrauterine Development ◽  
Elective Cesarean ◽  
Appropriate For Gestational Age ◽  
Student’S T ◽  
Circulating Levels ◽  
Student’S T Test

OBJECTIVE: Ghrelin is a GH secretagog isolated recently from rat stomach and involved in the stimulation of food intake and adiposity in rodents and humans. Moreover, subsequent studies showed that ghrelin is expressed in rat and human placenta, suggesting a possible influence of the peptide on fetal growth. The aim of this study was to evaluate circulating levels of ghrelin in appropriate for gestational age (AGA) or intrauterine growth-restricted (IUGR) fetuses. SUBJECTS AND METHODS: Ghrelin levels between 20 and 39 weeks of gestation were measured in 16 AGA and nine IUGR fetuses in whom blood was collected by cordocentesis performed for prenatal diagnosis of different diseases or during elective cesarean section. In most samples, GH, cortisol and leptin levels were also evaluated. Results are expressed as means+/-S.D. Differences were tested using the Student's t-test with Welch correction. P<0.05 was considered significant. RESULTS: All fetuses showed levels of ghrelin in the umbilical venous blood (100+/-99 pmol/l) that did not correlate with the gestational age or the maternal ghrelin levels. No difference was found between umbilical venous and arterial concentrations, suggesting that fetal tIssues are a source of ghrelin. Ghrelin levels in IUGR fetuses were significantly higher than those found in AGA fetuses (176+/-125 vs 58+/-44 pmol/l; P<0.005). Moreover, in samples obtained at birth, ghrelin concentrations correlated negatively with birth weight (P<0.05). In IUGR fetuses, GH and cortisol concentrations were higher and leptin levels lower than in AGA fetuses, although no significant correlation between these parameters and ghrelin levels was found. CONCLUSION: The presence of ghrelin in the fetal circulation as well as its increase in IUGR fetuses suggest a role of this peptide during intrauterine development.

scholarly journals Improving Neonatal and Maternal Outcome by Inducing Mild Labor before Elective Cesarean Section: The Lacarus Randomized Controlled Trial

Neonatology ◽  
2021 ◽  
pp. 1-6
Author(s):  
Sven Wellmann ◽  
Gwendolin Manegold-Brauer ◽  
Tina Fischer ◽  
Leonhard Schäffer ◽  
Vincent D. Gaertner ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Challenge Test ◽  
Well Being ◽  
Current Evidence ◽  
Elective Cesarean Section ◽  
Respiratory Morbidity ◽  
Uterine Contractions ◽  
Antenatal Steroids ◽  
Breastfeeding Rate ◽  
Elective Cesarean

<b><i>Background:</i></b> Newborns delivered by elective cesarean section (CS) are at higher respiratory risk than those delivered vaginally or by CS proceeded by labor (secondary CS). The oxytocin challenge test (OCT) induces uterine contractions that trigger the release of fetal hormones regulating lung fluid clearance during transition from the uterine to an air-breathing environment. <b><i>Objectives:</i></b> The aim is to summarize current evidence and outline the Lacarus trial protocol. <b><i>Methods:</i></b> Literature review informed the design of a randomized placebo-controlled multicenter trial of OCT preceding elective CS in 1,450 women with a singleton pregnancy due for CS at &#x3e;35 weeks gestation, without preceding contractions, rupture of the membranes, or antenatal steroids. OCT comprises the infusion of oxytocin 5 IU/500 mL Ringer lactate at a rate of 12 mL/h, doubling every 10 min until inducing 5 uterine contractions per 15-min interval. The primary endpoint is the occurrence of neonatal respiratory morbidity within 24 h after birth. Secondary endpoints include biochemical and physiological parameters of fetal and maternal well-being, such as breastfeeding rate and fetal plasma copeptin concentrations. <b><i>Conclusion:</i></b> This is the first trial to test the hypothesis that oxytocin-induced contractions before elective CS is a promising application of physiologic principles gleaned from natural birth to improve neonatal and maternal outcomes.

scholarly journals The Impact of Timing of Elective Cesarean Delivery at Term in Neonatal Respiratory Morbidity.

2020 ◽  
Vol 4 (2) ◽  
pp. 653-660
Author(s):  
Ajmone TROSHANI ◽  
Evda VEVECKA
Keyword(s):  
Caesarean Section ◽  
Gestational Age ◽  
Primary Outcome ◽  
Elective Caesarean Section ◽  
Respiratory Morbidity ◽  
Emergency Caesarean ◽  
Emergency Cesarean ◽  
Increased Risk ◽  
Elective Cesarean ◽  
The Impact

The aim is to investigate the association between elective caesarean sections and neonatal respiratory morbidity and the importance of timing of elective caesarean sections Methods; Cohort study with prospectively collected data of all elective Caesarean sections on mothers with a gestational age of 37+0 weeks and more, that were performed in our Hospital from 1 January 2011 to 1 January 2017. Multiple pregnancies, fetuses with congenital anomalies, intrauterine deaths, and emergency Caesarean sections were excluded. Primary outcome measures of neonatal respiratory morbidity included transient tachypnea of newborn, respiratory distress syndrome, persistent pulmonary hypertension of the newborn. Results; 4290 infants were delivered by elective caesarean section at 37+0 and then after Compared with newborns from vaginal delivery, and emergency cesarean section an increased risk of respiratory morbidity was found for infants delivered by elective caesarean section at 37 +0 weeks’ gestation to 37+6 weeks (odds ratio 5.7 95% confidence interval 4.3 to 8.9), 38+0 weeks’ gestation to 38+6 weeks (2.8, 2.1 to 4.2 ), and 39+0 weeks’ gestation (2.1, 1.5 to 2.8). Also increasing the incidence of admission to the NICU with decreasing gestational age at term birth below the 39 weeks of gestation Conclusions: Compared with newborn delivered vaginally or by emergency caesarean sections, those delivered by elective caesarean section around term have an increased risk of respiratory morbidity. The relative risk increased with decreasing gestational age.

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