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Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39405.539282.BE (Published 10 January 2008) Cite this as: BMJ 2008;336:85

Rapid Response:

Prevention of respiratory morbidity in clinically indicated elective caesarean section less than 39 weeks

Sir

The recent study by AKH et al (1) has helped to provide further evidence
that the risk of respiratory morbidity in term infants delivered by
Elective Caesarean section is increased. Over the years many studies have
been carried out and all have shown a similar result. (2) (3)

Following this results most NHS hospital have adopted policies that ensure
that Elective Caesarean sections are not performed before 39 weeks
gestation in uncomplicated/low risk pregnancy, except were clinically
indicated. In clinical practice, one often encounters patients requesting
Elective Caesarean sections for ‘social reasons’. Having shown that after
39weeks gestation the relative risk is no longer statistically significant
(1), obstetricians should make sure that when advising women on options
for delivery they should be given the adequate information, the overall
risks and benefits of caesarean section for both mother and baby as
compared to vaginal delivery should be explained especially the increased
risk of respiratory problems to the baby.

With an increasing number of patients opting for Elective Caesarean
section (patients choice), definitions of “Term” and Clinical indications
for Elective Caesarean section need to be debated (2).This will ensure
that the Gestational age of the fetus is accurate and will reduce the
number of clinical indicated Elective Caesarean sections that after
delivery are found to be of a lower gestational age and hence predisposed
to a higher incidence of respiratory morbidity.
It would also help to reduce the cost to NHS for level 1 and 2 care that
may need to be offered to this neonates if they are admitted to neonatal
intensive unit(2) and reduce the anxiety and stress that the parents face
during this period of admission.

In Clinical practice many factors influence the timing of elective
caesarean sections such as uncertainty on gestational age, medically
indicated early delivery and concerns about possible spontaneous onset of
labour and need for an emergency caesarean section with its antecedent
risks to mother and baby. Peter Stutchfield et al looked at whether
steroids would reduce respiratory distress in babies born by elective
caesarean section at term. They concluded that antenatal bethamethsone and
delaying delivery till 39weeks both reduce admissions to special care baby
units with respiratory distress after elective caesarean section at term
or give steroids prophylactic ally to those who are known to have
increased risk of pre-term labour (3).It has also been shown that one dose
of steroids has no long term adverse effects on infants either
neurological or cognitive.

More studies need to be carried out on this option of antenatal steroids
as this could be used in clinical practice where medical factors require
that a caesarean section needs to be performed before 39 weeks.The timing
of when the steroids would be given and the category of patients that
would benefit from the treatment should be looked at and possibly
guidelines could be made to incorporate this into our clinical practice.

The long term effects of steroids on the infants would also need to be
studied.

Mojisola Oniah, MBBS, FTSTA
Obstetrics & Gynaecology, Colchester
General Hospital, The UK

Sadia Farrakh, MBBS, FTSTA
Obstetrics & Gynaecology, Colchester
General Hospital, The Uk

Corresponding Author:
Mojisola Oniah.
Email: mojisaolamartinsdr@yahoo.com

References:

A K Hansen, Wisbourg K, Uldbjerg, T B HenriksenRisk of respiratory
morbidity in term infants delivered by elective caesarean section: cohort
study BMJ 2007:335

Alderdice F, McCall E, Bailie C, Craig S, Dornan J, McMillen R, Jenkins J.
Admission to neonatal intensive care with respiratory morbidity following
‘term’ elective caesarean. Ir Med J. 2005 Jun;98(6):170-2

Stutchfield P, Whitaker R, Russell I. Antenatal Betamethasone and
incidence of neonatal respiratory distress after elective caesarean
section: Pragmatic randomized trial.BMJ 2005:331

Competing interests:
None declared

Competing interests: No competing interests

08 January 2008
Mojisola. A. Oniah
FTSTA 1 Obstetrics & Gynaecology
Sadia farrakh
Colchester General Hospital, Turner road, CO4 5JL