RISKS ASSOCIATED WITH UNSCHEDULED C-SECTIONS PREVIOUS PLANNED DATES IN A TERTIARY CARE HOSPITAL, MUZAFFARABAD: A RETROSPECTIVE COHORT STUDY
Main Article Content
Keywords
Cesarean surgery, elective surgery, urgent surgery
Abstract
Background: Existing prediction tools for cesarean sections, whether scheduled or emergency, have relied on factors identified before and during labor.
Aim of the Study: The research focused on women with one viable fetus who underwent planned cesarean delivery at a tertiary care hospital, in Muzaffarabad.
Material and Methods: The retrospective cohort study gathered data from the hospital's medical records from February 2021 to September 2021. Women who had cesarean deliveries during this time and data was collected on their demographics, types of surgery, any existing health conditions, and details about the births.
The study also looked into the outcomes for both the mothers and the newborns after these deliveries, particularly comparing urgent and planned cesarean deliveries. A multivariate analysis was carried out to identify any factors related to cesarean deliveries that were performed earlier.
Results: The average age was significantly lower in the urgent cesarean group (30±5.3 years) compared to the elective cesarean group (31.4±5.1 years) with a p-value of 0.001. The gestational age at delivery was significantly shorter in the urgent cesarean group (37.5±1.8 weeks) than in the elective group (38.7±1.1 weeks, p<0.001).
Conclusion: Recent research reveals the factors that increase the risks and health issues for both the mother and fetus when elective cesarean deliveries need to be performed earlier than planned. Doctors should consider this when scheduling the cesarean delivery.
Aim of the Study: The research focused on women with one viable fetus who underwent planned cesarean delivery at a tertiary care hospital, in Muzaffarabad.
Material and Methods: The retrospective cohort study gathered data from the hospital's medical records from February 2021 to September 2021. Women who had cesarean deliveries during this time and data was collected on their demographics, types of surgery, any existing health conditions, and details about the births.
The study also looked into the outcomes for both the mothers and the newborns after these deliveries, particularly comparing urgent and planned cesarean deliveries. A multivariate analysis was carried out to identify any factors related to cesarean deliveries that were performed earlier.
Results: The average age was significantly lower in the urgent cesarean group (30±5.3 years) compared to the elective cesarean group (31.4±5.1 years) with a p-value of 0.001. The gestational age at delivery was significantly shorter in the urgent cesarean group (37.5±1.8 weeks) than in the elective group (38.7±1.1 weeks, p<0.001).
Gestational hypertension and a history of previous cesarean sections are both associated with increased odds of early cesarean deliveries (AOR 1.87, 95% Confidence interval (CI) 1.24 to 2.81, with a p-value of 0.002) and (AOR 1.34, 95% Confidence interval of 95%1.01 to 1.78, with a p-value of 0.043). Fetal distress appeared as the strongest predictor, significantly raising the odds of early cesarean deliveries (AOR 3.12, 95% CI 95%, 2.15 to 4.53, with a highly significant p-value less than 0.001
Conclusion: Recent research reveals the factors that increase the risks and health issues for both the mother and fetus when elective cesarean deliveries need to be performed earlier than planned. Doctors should consider this when scheduling the cesarean delivery.
References
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16. Danieli-Gruber S, Shalev-Rosenthal Y, Matot R, Brzezinski-Sinai N, Zeevi G, Pardo A, et al. Risks of urgent cesarean delivery preceding the planned schedule: A retrospective cohort study. PLoS One [Internet]. 2023;18(8 August):1–12. Available from: http://dx.doi.org/10.1371/journal.pone.0289655
17. Pierre Amarenco, Julien Bogousslavsky, Alfred Callahan 3rd, Larry B Goldstein, Michael Hennerici, Amy E Rudolph, Henrik Sillesen, Lisa Simunovic, Michael Szarek, K M A Welch, Justin A Zivin SP by AR in CL (SPARCL) I. Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes. N Engl J Med. 2011;365:687–96.
18. Clark SL, Miller DD, Belfort MA, Dildy GA, Frye DK, Meyers JA. Neonatal and maternal outcomes associated with elective term delivery. Am J Obstet Gynecol [Internet]. 2009 [cited 2024 May 30];200(2):156.e1-156.e4. Available from: https://pubmed.ncbi.nlm.nih.gov /19110225/
19. Melamed N, Hadar E, Keidar L, Peled Y, Wiznitzer A, Yogev Y. Timing of planned repeat cesarean delivery after two or more previous cesarean sections--risk for unplanned cesarean delivery and pregnancy outcome. J Matern Fetal Neonatal Med [Internet]. 2014 Mar [cited 2024 May 30];27(5):431–8. Available from: https://pubmed.ncbi.nlm.nih.gov/23795868/
20. Glavind J, Henriksen TB, Kindberg SF, Uldbjerg N. Randomised trial of planned caesarean section prior to versus after 39 weeks: unscheduled deliveries and facility logistics--a secondary analysis. PLoS One [Internet]. 2013 Dec 20 [cited 2024 May 30];8(12). Available from: https://pubmed.ncbi.nlm.nih.gov/24376842/
21. Sibai BM, Lindheimer M, Hauth J, Caritis S, VanDorsten P, Klebanoff M, et al. Risk factors for preeclampsia, abruptio placentae, and adverse neonatal outcomes among women with chronic hypertension. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. N Engl J Med [Internet]. 1998 Sep 3 [cited 2024 May 30];339(10):667–71. Available from: https://pubmed.ncbi.nlm.nih.gov/9725924/
22. Rey E, Couturier A. The prognosis of pregnancy in women with chronic hypertension. Am J Obstet Gynecol [Internet]. 1994 [cited 2024 May 30];171(2):410–6. Available from: https://pubmed.ncbi.nlm.nih.gov/8059820/
2. Izadnegahdar R, Cohen AL, Klugman KP, Qazi SA. Childhood pneumonia in developing countries. Lancet Respir Med [Internet]. 2013 Sep [cited 2024 Feb 13];1(7):574–84. Available from: https://pubmed.ncbi.nlm.nih.gov/24461618/
3. Wells JC, Wibaek R, Poullas M. Global epidemiology of use of and disparities in caesarean sections. Lancet (London, England) [Internet]. 2019 Jul 6 [cited 2024 May 29];394(10192):24–5. Available from: https://pubmed.ncbi.nlm.nih.gov/31282355/
4. Pettker M, Funai EF, Illuzzi JL. Contributing Indications to the Rising Cesarean Delivery Rate. Obstet Gynecol. 2013;118(1):29–38.
5. Marcum Zachary A, Sevick MA HS. Primary Cesarean Delivery in the United States. Jama. 2013;309(20):2105–6.
6. McNay EC, Ong CT, McCrimmon RJ, Cresswell J, Bogan JS, Sherwin RS. Obstetric Complications, Neonatal Morbidity, and Indications for Cesarean Delivery by Maternal Age. Bone [Internet]. 2008;23(1):1–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles /PMC3624763/pdf/nihms412728.pdf
7. Arieh Riskin RG. Does cesarean section before the scheduled date increase the risk of neonatal morbidity? - PubMed [Internet]. [cited 2024 May 29]. Available from: https://pubmed.ncbi.nlm.nih.gov/25351013/
8. Prediger B, Mathes T, Polus S, Glatt A, Bühn S, Schiermeier S, et al. A systematic review and time-response meta-analysis of the optimal timing of elective caesarean sections for best maternal and neonatal health outcomes. BMC Pregnancy Childbirth. 2020;20(1):1–18.
9. Sananès N, Haller L, Jochum F, Koch A, Lecointre L, Rozenberg P. Morbidity associated with planned cesarean deliveries performed before the scheduled date: A cohort study. Eur J Obstet Gynecol Reprod Biol. 2021;264:83–7.
10. Wilmink FA, Hukkelhoven CWPM, Lunshof S, Mol BWJ, van der Post JAM, Papatsonis DNM. Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: a 7-year retrospective analysis of a national registry. Am J Obstet Gynecol [Internet]. 2010 Mar 1 [cited 2024 May 29];202(3):250.e1-250.e8. Available from: http://www.ajog.org/article/S000 2937810000827/fulltext
11. Nir V, Nadir E, Feldman M. Late better than early elective term Cesarean section. Acta Paediatr [Internet]. 2012 Oct 1 [cited 2024 May 29];101(10):1054–7. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1651-2227.2012.02772.x
12. Glavind J, Kindberg SF, Uldbjerg N, Khalil M, Møller AM, Mortensen BB, et al. Elective caesarean section at 38 weeks versus 39 weeks: neonatal and maternal outcomes in a randomised controlled trial. BJOG [Internet]. 2013 Aug [cited 2024 May 29];120(9):1123–32. Available from: https://pubmed.ncbi.nlm.nih.gov/23682628/
13. Armson BA. Is planned cesarean childbirth a safe alternative? C Can Med Assoc J [Internet]. 2007 Feb 2 [cited 2024 May 29];176(4):475. Available from: /pmc/articles/PMC1800576/
14. Declercq E, Barger M, Cabral HJ, Evans SR, Kotelchuck M, Simon C, et al. Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births. Obstet Gynecol [Internet]. 2007 Mar [cited 2024 May 29];109(3):669–77. Available from: https://pubmed.ncbi.nlm.nih.gov/17329519/
15. Gynecologists AC of O and. Medically Indicated Late-Preterm and Early-Term Deliveries: ACOG Committee Opinion, Number 831. Obstet Gynecol [Internet]. 2021 Jul 1 [cited 2024 May 29];138(1):E35–9. Available from: https://pubmed.ncbi.nlm.nih.gov/34259491/
16. Danieli-Gruber S, Shalev-Rosenthal Y, Matot R, Brzezinski-Sinai N, Zeevi G, Pardo A, et al. Risks of urgent cesarean delivery preceding the planned schedule: A retrospective cohort study. PLoS One [Internet]. 2023;18(8 August):1–12. Available from: http://dx.doi.org/10.1371/journal.pone.0289655
17. Pierre Amarenco, Julien Bogousslavsky, Alfred Callahan 3rd, Larry B Goldstein, Michael Hennerici, Amy E Rudolph, Henrik Sillesen, Lisa Simunovic, Michael Szarek, K M A Welch, Justin A Zivin SP by AR in CL (SPARCL) I. Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes. N Engl J Med. 2011;365:687–96.
18. Clark SL, Miller DD, Belfort MA, Dildy GA, Frye DK, Meyers JA. Neonatal and maternal outcomes associated with elective term delivery. Am J Obstet Gynecol [Internet]. 2009 [cited 2024 May 30];200(2):156.e1-156.e4. Available from: https://pubmed.ncbi.nlm.nih.gov /19110225/
19. Melamed N, Hadar E, Keidar L, Peled Y, Wiznitzer A, Yogev Y. Timing of planned repeat cesarean delivery after two or more previous cesarean sections--risk for unplanned cesarean delivery and pregnancy outcome. J Matern Fetal Neonatal Med [Internet]. 2014 Mar [cited 2024 May 30];27(5):431–8. Available from: https://pubmed.ncbi.nlm.nih.gov/23795868/
20. Glavind J, Henriksen TB, Kindberg SF, Uldbjerg N. Randomised trial of planned caesarean section prior to versus after 39 weeks: unscheduled deliveries and facility logistics--a secondary analysis. PLoS One [Internet]. 2013 Dec 20 [cited 2024 May 30];8(12). Available from: https://pubmed.ncbi.nlm.nih.gov/24376842/
21. Sibai BM, Lindheimer M, Hauth J, Caritis S, VanDorsten P, Klebanoff M, et al. Risk factors for preeclampsia, abruptio placentae, and adverse neonatal outcomes among women with chronic hypertension. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. N Engl J Med [Internet]. 1998 Sep 3 [cited 2024 May 30];339(10):667–71. Available from: https://pubmed.ncbi.nlm.nih.gov/9725924/
22. Rey E, Couturier A. The prognosis of pregnancy in women with chronic hypertension. Am J Obstet Gynecol [Internet]. 1994 [cited 2024 May 30];171(2):410–6. Available from: https://pubmed.ncbi.nlm.nih.gov/8059820/
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Published
Dec 20, 2021
Article Details
How to Cite
Nosheena Akhter Shabbir, Hina Pirzada, Seemab Zafar, Zahida Anwar, Mehru Fatima, & Kainat Rashid. (2021). RISKS ASSOCIATED WITH UNSCHEDULED C-SECTIONS PREVIOUS PLANNED DATES IN A TERTIARY CARE HOSPITAL, MUZAFFARABAD: A RETROSPECTIVE COHORT STUDY. Journal of Population Therapeutics and Clinical Pharmacology, 28(2), 361-366. https://doi.org/10.53555/jptcp.v28i2.6585
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Author Biographies
Nosheena Akhter Shabbir
MBBS, FCPS Obstetrics and Gynecology, CMH/SKBZ Muzaffarabad, Assistant Professor AJK Medical College
Hina Pirzada
MBBS, FCPS Obstetrics and Gynecology, Assistant Professor AJK Medical College
Seemab Zafar
MBBS, FCPS Obstetrics and Gynecology, Assistant Professor AJK Medical College
Zahida Anwar
MBBS, Registrar Obstetrics and Gynecology, Registrar CMH/SKBZ
Mehru Fatima
MBBS, Resident Obstetrics and Gynecology, CMH/SKBZ Muzaffarabad AJK, Pakistan,
Kainat Rashid
MBBS Student, Women Medical College, Abbottabad Pakistan
How to Cite
Nosheena Akhter Shabbir, Hina Pirzada, Seemab Zafar, Zahida Anwar, Mehru Fatima, & Kainat Rashid. (2021). RISKS ASSOCIATED WITH UNSCHEDULED C-SECTIONS PREVIOUS PLANNED DATES IN A TERTIARY CARE HOSPITAL, MUZAFFARABAD: A RETROSPECTIVE COHORT STUDY. Journal of Population Therapeutics and Clinical Pharmacology, 28(2), 361-366. https://doi.org/10.53555/jptcp.v28i2.6585