COMPARISON OF MATERNAL AND PERINATAL OUTCOME IN ELECTIVE REPEAT CAESAREAN SECTION DONE BEFORE 39 WEEKS AND THOSE DONE AT OR AFTER 39 WEEKS OF GESTATION

INTRODUCTION: Caesarean sections are one of the commonest surgeries performed in the world today. The timing of scheduling an elective repeat cesarean section has been an issue of debates Because of increased risks of complications for the infants of respiratory and other complications. We assessed associations between elective cesarean delivery before 39 weeks compared to delivery at or after 39 weeks of gestation and studied the maternal and neonatal outcomes in these two groups. OBJECTIVES: To compare the maternal and neonatal outcomes in the women with previous cesarean sections who underwent elective repeat caesarean section before 39 weeks gestation to those who had it at or after 39 weeks gestation. MATERIAL AND METHODS: The study period was of one year duration from April 2011 to March 2012 during which the patients who underwent elective repeat caesarean section in our institution The Institute of Maternal and Child Health, Government Medical College, Kozhikode a tertiary level referral center were studied. This was a prospective cohort study involving a total of 300 cases of elective repeat cesarean section during this period. STATISTICAL ANALYSIS: Statistical significance of different variables were analyzed using the Pearson chi-square test. The data obtained were analyzed using the SPSS program. RESULTS: The No of repeat elective caesarean sections performed in the institution during the study period was 1817. Of these 300 cases were included in the study with 150 patients having repeat elective caesarean section before 39 weeks and 150 women having it at 39 weeks or after 39 weeks. The study showed that early elective delivery before 39 weeks did not significantly reduce the risk of adverse maternal outcomes compared to delivery after 39 weeks. However our study showed a significant difference in the neonatal outcome between the two groups with the babies in the group delivered before 39 weeks requiring more NICU admissions (24 compared to 1 case in the control group P value <0.0001) with increased incidence of respiratory distress, hypoglycemia, sepsis and seizures. CONCLUSIONS: The study highlights the benefits of delaying elective repeat caesarean sections until completion of 39 weeks of gestation which was shown to significantly improve the perinatal morbidity.