Respiratory Morbidity in Neonates at or Near-Term in Relation to Mode of Delivery - A Retrospective Observational Study
Fouzia Rasool Memon
Consultant Obstetrician and Gynaecologist, North Cumbria University Hospital, United Kingdom.
Asma Naz
Department of Obstetrics and Gynaecology, People’s University of Medical and Health Sciences for Women (PUMHSW), Nawabshah, Sindh, Pakistan.
Nusrat Fozia Pathan
Department of Obstetrics and Gynaecology, Khairpur Medical College, Khairpur Mirs, Sindh, Pakistan.
Shahida Baloch
Department of Surgery, People’s University of Medical and Health Sciences for Women (PUMHSW), Nawabshah, Sindh, Pakistan.
Ameer Ali Jamali
Department of Paediatrics, People’s University of Medical and Health Sciences for Women (PUMHSW), Nawabshah, Sindh, Pakistan.
Fareeda Wagan
Department of Obstetrics and Gynaecology, People’s University of Medical and Health Sciences for Women (PUMHSW), Nawabshah, Sindh, Pakistan.
Arslan Ahmer *
Institute of Pharmaceutical Sciences, People’s University of Medical and Health Sciences for Women (PUMHSW), Nawabshah, Sindh, Pakistan.
*Author to whom correspondence should be addressed.
Abstract
Introduction: Antenatal corticosteroids are recommended by Royal College of Obstetrics and Gynaecology for caesarean section planned before thirty-eight plus six weeks gestation. However, these steroids are, not suggested for labour induced electively after thirty four weeks.
Objective: This study’s aim is to enumerate the possibility of respiratory morbidity in neonates for various deliberated approaches of delivery between thirty-five and thirty eight weeks gestation.
Methodology: This study was carried out during June 2018 and December 2020 at a tertiary obstetric unit and analysed 3796 neonates delivered between thirty-five and thirty eight weeks gestation for neonatal admission due to respiratory morbidity.
Results: The risk for respiratory problems in spontaneous labour was 9.9% (16/161), 5.0% (12/238), 1.2% (5/426) and 0.64% (6/930) at thirty five, thirty six, thirty seven and thirty eight weeks of gestation respectively. For induced labour, it was 25% (4/16), 4.8% (5/104), 4.1% (13/318) and 0.82% (4/485) at thirty-five, thirty six, thirty seven and thirty eight weeks respectively. While the risk of respiratory morbidity in elective caesarean section, was 13.8% (4/29), 27.1% (13/48), 4.1% (5/122) and 2.8% (9/318) at thirty-five, thirty six, thirty seven and thirty eight weeks respectively. Overall chance of respiratory morbidity in neonates was 6% after elective caesarean section, 2.8% after labour induction and 2.2% after spontaneous labour (p< 0.0001). The number of neonates with respiratory problems born by elective C-section was only 31 out of total 132 (23.5%). Whereas this risk was 2.8% at 35-38 weeks and 5.0% at 35-37 weeks after induced labour.
Conclusion: Elective delivery at 35-38 weeks is linked to respiratory morbidity in new born babies. More research is required to assess the role of prophylactic corticosteroids preceding elective induction of labour.
Keywords: Neonatal respiratory morbidity, induction of labour, caesarean section