Maternal and Fetal Outcome of Elective Caesarean Section at 37 – 38 Weeks versus 39 Completed Weeks of Gestation in Enugu, Southeast Nigeria

Abstract

A retrospective study comparing maternal and neonatal outcome of singleton fetuses delivered at 37-38 weeks of completed gestation with those delivered at 39 completed weeks of gestation or longer by elective caesarean section at the University of Nigeria Teaching Hospital, Enugu between January 1, 2004 and December 31, 2008. There were 164(21.3%) elective caesarean deliveries during the study period. 117 (71.3%) were performed between 37-38 weeks of completed gestation and 47(28.7%) at 39 completed weeks of gestation. Elective caesarean births at 37-38 weeks were associated with significantly higher rates of admission to the neonatal care unit, neonatal jaundice, and a higher proportion of newborns with Apgar score <6 at 5minutes. As a result of increased morbidity and iatrogenic prematurity in the developing countries due to elective caesarean delivery at 37-38weeks associated with increased cost of admissions in the newborn special care units, elective caesarean delivery should be advised at or after 39 weeks of gestation unless there is evidence of fetal lung maturity. At 39 completed weeks of gestation, elective caesarean delivery is associated with better fetal outcomes than at 37-38 weeks of completed gestation.

Vaginal Birth After Previous Caesarean Section

“…Current study demonstrated that BMI was directly associated with FTOL, this relationship was shown by several previous studies like; [13] [19] demonstrated that the risk for caesarean delivery increases as BMI increases > 40 among nulliparous extremely obese women attempting a trial of labor, further increases in BMI > 40 among parous women attempting a TOL does not seem to add additional risk for cesarean delivery [24]. [25] study (reviewed 1.516 patients who underwent VBAC and found that an inter delivery interval of less than 19 months was associated with a decrease rate of successful VBAC). In contrast, Bujold and colleagues, reviewed 1.527 women attempting VBAC and found that an inter delivery interval of 24 months or less was associated with no difference in VBAC success rates [21].…”

Factors Affecting Acceptance of Caesarean Section among Childbearing Age Women in Ebute-Metta, Lagos Mainland Local Government in Lagos State, Nigeria

“…The incidence of caesarean deliveries at the University of Nigeria Teaching Hospital is 25% with elective caesarean section constituting 21.3% of all caesarean deliveries (Okezie, Oyefara & Chigbu, 2007;Okeke et al, 2013). There is a growing opinion that elective caesarean section should not be done before 38 weeks unless there is evidence of foetal lung maturity to avoid adverse neonatal outcomes (Treffers, 1993: Okeke et al, 2013.…”

“…The incidence of caesarean deliveries at the University of Nigeria Teaching Hospital is 25% with elective caesarean section constituting 21.3% of all caesarean deliveries (Okezie, Oyefara & Chigbu, 2007;Okeke et al, 2013). There is a growing opinion that elective caesarean section should not be done before 38 weeks unless there is evidence of foetal lung maturity to avoid adverse neonatal outcomes (Treffers, 1993: Okeke et al, 2013. Several studies have documented high incidence of respiratory problem, the newborn special care unit admission, prolonged hospitalisation, low Apgar score, iatrogenic prematurity, surfactant deficiency, and transient tachypnoea of newborn (Donaldson & Dagbjatson, 2007), following elective caesarean delivery (Okeke et al, 2013).…”