An old problem revisited-hyaline membrane disease and cesarean section

Abstract

The incidence of hyaline membrane disease (HMD) was investigated retrospectively in 159 preterm infants below 35 weeks gestation, weighing less than 2,000 g, and born during the 5-year interval 1975-79. The incidence of HMD was compared between infants delivered by elective Cesarean section, Cesarean section after the onset of labor and by the vaginal route. A significant difference (P less than 0.001) was found in the frequency of HMD dependent on the mode of delivery; 50% of infants delivered by elective Cesarean section developed HMD versus 19.2% in the vaginally delivered group. In infants delivered vaginally premature rupture of membranes (PROM) lowered the incidence of HMD to 5% compared to 32.4% in infants without PROM (P less than 0.01). When infants (less than 2,000 g) delivered vaginally without PROM were compared with those delivered by elective Cesarean section, no difference in HMD-incidence was observed. Out of 43 infants with birthweight above 2,000 g, who developed HMD during the 5-year period the majority had been delivered by elective Cesarean section. The possible effect of fetal stress on lung maturation is discussed.

Epidemiological Analysis of the Increased Risk of Disturbed Neonatal Respiratory Adaptation after Caesarean Section

“…Previous studies have usually concerned a more or less well-defined clinical entity, the respiratory distress syndrome (RDS), or hyaline membrane disease, also called IRDS. An increased rate of these disorders after CS has been found (1,10). As we have included all types and degrees of respiratory disturbances in this study, we were able to show that not only the most severe conditions (IRDS or HMD) but also transient signs of disturbed postnatal respiratory adaptation were more common after CS than after vaginal delivery.…”

Effects of labor contractions on catecholamine release and breathing frequency in newborn rats.

“…Elective cesarean section of human infants is associated with respiratory morbidity, including respiratory distress, transient tachypnea, hyaline membrane disease, and persistent pulmonary hypertension (Brice & Walker, 1977; Cohen & Carson, 1985; Faxelius, Bremme, & Lagercrantz, 1982; Levine et al, 2001; van den Berg, van Elburg, van Geijn, & Fetter, 2001; Usher, Allen, & McLean, 1971; Zanardo et al, 2004). In our study, despite the group differences in breathing frequencies early in the postpartum measurement interval, we observed in each birth condition inverse correlations indicating that low plasma catecholamines were associated with higher respiratory rates.…”

Volume loading before caesarean section under spinal or epidural anaesthesia: colloids versus crystalloids?

“…Respiratory problems in the neonatal period are much more common in infants delivered by elective CS than in those vaginally delivered (19)(20)(21). It has been speculated that maternal volume loading with colloids would theoretically represent an advantage from a fetal point of view, since there is indirect evidence that crystalloid prehydration to the mother may increase the fetal water load (10, 22).…”